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General NPI Number Information
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NPI Number | 1073455523
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Entity Type | Individual
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Provider Name | JADE RAY SAMANTA
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Gender | Male
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Dates
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Enumeration Date | 04/06/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 200 HAWKINS DR
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City | IOWA CITY
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State | IA
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Zip | 52242-1009
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Country | US
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Telephone | 573-579-2422
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Fax |
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Provider Business Mailing Address
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Address Line | 1163 BENTON WAY
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City | ARDEN HILLS
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State | MN
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Zip | 55112-3753
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Country | US
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Telephone | 319-384-7620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | IA
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