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General NPI Number Information
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NPI Number | 1851065734
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Entity Type | Individual
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Provider Name | AILISH SAMUELSON PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 18 BROWNSKNOLL LN
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City | EAGLE BRIDGE
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State | NY
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Zip | 12057-2307
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Country | US
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Telephone | 518-290-0554
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Fax |
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Provider Business Mailing Address
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Address Line | 18 BROWNSKNOLL LN
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City | EAGLE BRIDGE
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State | NY
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Zip | 12057-2307
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Country | US
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Telephone | 518-919-3982
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Fax | 479-334-3222
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0
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License Number State | NY
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