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General NPI Number Information
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NPI Number | 1013715366
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Entity Type | Organization
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Legal Business Name | WELL LIFE WITH SAM, LLC
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 7935 HERON WAY
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City | KING GEORGE
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State | VA
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Zip | 22485-7391
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Country | US
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Telephone | 217-202-5701
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Fax |
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Provider Business Mailing Address
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Address Line | 2003 PLANK RD # 1072
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-5103
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Country | US
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Telephone | 217-202-5701
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/ OWNER
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Name | SAMANTHA COGIL
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Credential | NP
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Telephone | 217-202-5701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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