Healthcare Provider Details

I. General information

NPI: 1548930738
Provider Name (Legal Business Name): SAMANTHA HERRADURA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 7TH AVE
SEATTLE WA
98104-1132
US

IV. Provider business mailing address

1145 BROADWAY FL 2
SEATTLE WA
98122-4201
US

V. Phone/Fax

Practice location:
  • Phone: 206-329-1760
  • Fax:
Mailing address:
  • Phone: 206-860-4669
  • Fax: 206-860-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61209738
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: