Healthcare Provider Details

I. General information

NPI: 1225641194
Provider Name (Legal Business Name): MISS SAMANTHA LYNN DEANDREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W. 6TH ST.
RENO NV
89503
US

IV. Provider business mailing address

1955 W. 6TH ST.
RENO NV
89503
US

V. Phone/Fax

Practice location:
  • Phone: 570-582-0711
  • Fax: 775-828-6413
Mailing address:
  • Phone: 570-582-0711
  • Fax: 775-828-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: