Healthcare Provider Details

I. General information

NPI: 1841106713
Provider Name (Legal Business Name): SAMANTHA RAYNE VALENTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SW LEE ST
NEWPORT OR
97365-3823
US

IV. Provider business mailing address

51 SW LEE ST
NEWPORT OR
97365-3823
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-0600
  • Fax: 541-265-0601
Mailing address:
  • Phone: 541-265-0600
  • Fax: 541-265-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number118069
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: