Healthcare Provider Details

I. General information

NPI: 1831488345
Provider Name (Legal Business Name): SAMUALLA L. PRY LSW,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S STEWART ST STE 1001
CARSON CITY NV
89701-5251
US

IV. Provider business mailing address

206 S DIVISION ST
CARSON CITY NV
89703-4276
US

V. Phone/Fax

Practice location:
  • Phone: 775-684-7012
  • Fax: 775-684-7026
Mailing address:
  • Phone: 775-303-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4872-M
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: