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General NPI Number Information
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NPI Number | 1811692817
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Entity Type | Individual
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Provider Name | FAITH SAMAAN
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Gender | Female
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Dates
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Enumeration Date | 03/31/2023
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 24850 SE STARK ST STE 200
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City | GRESHAM
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State | OR
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Zip | 97030-8320
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Country | US
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Telephone | 503-317-5036
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Fax |
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Provider Business Mailing Address
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Address Line | 5380 SE 18TH ST
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City | GRESHAM
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State | OR
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Zip | 97080-3012
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Country | US
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Telephone | 503-317-5036
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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 | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | 10190241
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-30730
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License Number State |
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