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General NPI Number Information
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NPI Number | 1215316591
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Entity Type | Individual
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Provider Name | GIA SAMUEL
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Gender | Female
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 6217 GARDENIA ST
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City | PHILADELPHIA
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State | PA
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Zip | 19144-1608
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Country | US
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Telephone | 484-903-5896
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Fax |
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Provider Business Mailing Address
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Address Line | 13305 228TH ST
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City | LAURELTON
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State | NY
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Zip | 11413-1746
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Country | US
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Telephone | 718-527-1805
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 321856-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN782298
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License Number State | PA
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