Healthcare Provider Details

I. General information

NPI: 1568134542
Provider Name (Legal Business Name): SAMANTHA RAE LOCKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 LEVIN RD NW
SILVERDALE WA
98383-8399
US

IV. Provider business mailing address

PO BOX 1228
SUQUAMISH WA
98392-1228
US

V. Phone/Fax

Practice location:
  • Phone: 360-307-7202
  • Fax:
Mailing address:
  • Phone: 360-982-4527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP.AP.61417194-CNM
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: