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General NPI Number Information
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NPI Number | 1134480957
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Entity Type | Individual
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Provider Name | KRISTINA SAMU NP
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Gender | Female
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 1065 N HURON RIVER DR
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City | YPSILANTI
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State | MI
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Zip | 48197-3296
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Country | US
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Telephone | 734-896-4112
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Fax | 734-896-4113
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Provider Business Mailing Address
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Address Line | 1065 N HURON RIVER DR
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City | YPSILANTI
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State | MI
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Zip | 48197-3296
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Country | US
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Telephone | 734-896-4112
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Fax | 734-896-4113
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704263263
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License Number State | MI
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