Healthcare Provider Details

I. General information

NPI: 1265041172
Provider Name (Legal Business Name): SAMANTHA M JOANETTE R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 MARGARET TERRANCE MEMORIAL WAY
AKWESASNE NY
13655-3236
US

IV. Provider business mailing address

404 STATE ROUTE 37
AKWESASNE NY
13655
US

V. Phone/Fax

Practice location:
  • Phone: 518-358-3145
  • Fax:
Mailing address:
  • Phone: 518-358-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number707497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: