Healthcare Provider Details

I. General information

NPI: 1811692817
Provider Name (Legal Business Name): FAITH SAMAAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24850 SE STARK ST STE 200
GRESHAM OR
97030-8320
US

IV. Provider business mailing address

5380 SE 18TH ST
GRESHAM OR
97080-3012
US

V. Phone/Fax

Practice location:
  • Phone: 503-317-5036
  • Fax:
Mailing address:
  • Phone: 503-317-5036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number10190241
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-30730
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: