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NPI Code Detail

MEDICARE: SAMANTHA AIKEN CRNA

MEDICARE: SAMANTHA AIKEN CRNA
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
1367500000XCertified Registered Nurse AnesthetistR63497AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578545158
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA AIKEN CRNA
Provider Business Mailing Address
First Line : 3396 N FUTRALL DR
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4057
Country : US
Telephone Number : 479-582-1938
Fax Number :
Provider Business Practice Location Address
First Line : 3396 N FUTRALL DR
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4057
Country : US
Telephone Number : 479-582-1938
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 04/27/2009

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