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General NPI Number Information
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NPI Number | 1417760844
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Entity Type | Individual
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Provider Name | SAMANTHA M VANDEROSTYNE RNFA
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Gender | Female
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 9003 E SHEA BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6709
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Country | US
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Telephone | 480-332-7336
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Fax | 480-281-5224
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Provider Business Mailing Address
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Address Line | PO BOX 50924
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City | PHOENIX
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State | AZ
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Zip | 85076-0924
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Country | US
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Telephone | 480-980-8206
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Fax | 480-281-5224
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | RN240103
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License Number State | AZ
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