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General NPI Number Information
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NPI Number | 1811650849
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Entity Type | Individual
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Provider Name | GRACE MARIE SAMSON APRN
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Gender | Female
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Dates
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Enumeration Date | 10/17/2021
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Last Update Date | 10/17/2021
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Provider Practice Location Address
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Address Line | 3059 S MARYLAND PKWY STE 202
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City | LAS VEGAS
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State | NV
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Zip | 89109-6209
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Country | US
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Telephone | 702-680-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 3059 S MARYLAND PKWY STE 2023059S
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City | LAS VEGAS
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State | NV
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Zip | 89109-2294
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Country | US
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Telephone | 702-680-1500
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 837808
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License Number State | NV
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