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General NPI Number Information
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NPI Number | 1487436341
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Entity Type | Individual
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Provider Name | SAMARA WRIGHT
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Gender | Female
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 4260 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10033-3726
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Country | US
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Telephone | 212-923-8451
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Fax |
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Provider Business Mailing Address
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Address Line | 462 8TH ST APT 2
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City | BROOKLYN
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State | NY
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Zip | 11215-3616
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Country | US
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Telephone | 609-401-7698
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 383616
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License Number State | NY
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