Healthcare Provider Details

I. General information

NPI: 1124941810
Provider Name (Legal Business Name): SAMANTHA JAE DAVIS CRM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 GOLDFISH FARM RD SE
ALBANY OR
97322-5154
US

IV. Provider business mailing address

3660 DIAN AVE NE
ALBANY OR
97322-4324
US

V. Phone/Fax

Practice location:
  • Phone: 541-967-6580
  • Fax:
Mailing address:
  • Phone: 541-967-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number26-CRM-5722
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: