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NPI Code Detail

MEDICARE: SAMANTHA HUSTAK

MEDICARE: SAMANTHA HUSTAK
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1639864887
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA HUSTAK
Provider Business Mailing Address
First Line : 2108 E THOMAS RD STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-0008
Country : US
Telephone Number : 402-659-3927
Fax Number :
Provider Business Practice Location Address
First Line : 2108 E THOMAS RD STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7761
Country : US
Telephone Number : 402-659-3927
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2023
Last Update Date : 04/05/2023

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Directions to “ SAMANTHA HUSTAK ” Practice Location

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