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NPI Code Detail

MEDICARE: SAMANTHA HOLMES

MEDICARE: SAMANTHA HOLMES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1033817598
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA HOLMES
Provider Business Mailing Address
First Line : PO BOX 876741
Second Line :
City : WASILLA
State : AK
Zip : 99687-6741
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 950 S SNODGRASS DR
Second Line :
City : PALMER
State : AK
Zip : 99645-9750
Country : US
Telephone Number : 907-373-4732
Fax Number : 907-746-4749
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2023
Last Update Date : 08/16/2023

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Directions to “ SAMANTHA HOLMES ” Practice Location

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