Healthcare Provider Details

I. General information

NPI: 1982367348
Provider Name (Legal Business Name): CHRISTINE MARIE SAMUEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-3000
  • Fax: 910-667-9758
Mailing address:
  • Phone: 336-713-5440
  • Fax: 336-713-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11633
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: