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General NPI Number Information
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NPI Number | 1114595139
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Entity Type | Individual
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Provider Name | VANESA ELIZABETH SAMOS FNP
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Gender | Female
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 1732 STATE ROUTE 67
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City | VALLEY FALLS
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State | NY
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Zip | 12185-3445
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Country | US
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Telephone | 928-246-1555
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Fax |
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Provider Business Mailing Address
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Address Line | 1732 STATE ROUTE 67
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City | VALLEY FALLS
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State | NY
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Zip | 12185-3445
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Country | US
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Telephone | 928-246-1555
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 347264
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License Number State | NY
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