Healthcare Provider Details

I. General information

NPI: 1174341218
Provider Name (Legal Business Name): SAMANTHA STOKES-NOLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 JACKIE RD SE STE 900
RIO RANCHO NM
87124-6612
US

IV. Provider business mailing address

1316 JACKIE RD SE STE 900
RIO RANCHO NM
87124-6612
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-9892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: