Healthcare Provider Details

I. General information

NPI: 1447849724
Provider Name (Legal Business Name): DEBORAH VICTORIA SAMPSON REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N 45TH ST
SEATTLE WA
98103-6902
US

IV. Provider business mailing address

3811C ASHWORTH AVE N
SEATTLE WA
98103-8118
US

V. Phone/Fax

Practice location:
  • Phone: 206-633-5089
  • Fax:
Mailing address:
  • Phone: 206-633-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN00064647
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: