Healthcare Provider Details

I. General information

NPI: 1972425437
Provider Name (Legal Business Name): SAMSON PETER MVANDAL RN, BSN, PDN, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12433 SE 275TH PL
KENT WA
98030-8518
US

IV. Provider business mailing address

32200 MILITARY RD S APT N304
FEDERAL WAY WA
98001-9659
US

V. Phone/Fax

Practice location:
  • Phone: 360-500-3652
  • Fax:
Mailing address:
  • Phone: 360-500-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61630184
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: