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General NPI Number Information
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NPI Number | 1568816882
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Entity Type | Individual
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Provider Name | SAMANTHA STEVENS
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Gender | Female
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 1823 CAMINO DE SALUD
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-3782
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Country | US
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Telephone | 505-272-1754
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Fax | 505-925-4594
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Provider Business Mailing Address
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Address Line | 1823 CAMINO DE SALUD
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-3782
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Country | US
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Telephone | 505-272-1754
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Fax | 505-925-4594
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0004612
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2024-0024
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License Number State | NM
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