Healthcare Provider Details

I. General information

NPI: 1144094426
Provider Name (Legal Business Name): SAMANTHA KATE HEMENWAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 MORGAN TRL
EDMOND OK
73012-6661
US

IV. Provider business mailing address

2904 MORGAN TRL
EDMOND OK
73012-6661
US

V. Phone/Fax

Practice location:
  • Phone: 575-420-1388
  • Fax:
Mailing address:
  • Phone: 575-420-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number57629
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: