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NPI Code Detail

MEDICARE: DEBORAH ANNE SAMOSON NURSE PRACTITIONER

MEDICARE: DEBORAH ANNE SAMOSON NURSE PRACTITIONER
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
1363L00000XNurse Practitioner614758TX
2363L00000XNurse Practitioner67918NM
3363L00000XNurse Practitioner10024068OR

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 : 1801804430
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH ANNE SAMOSON NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 408 W 45TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78751-3014
Country : US
Telephone Number : 512-451-5800
Fax Number : 512-451-6341
Provider Business Practice Location Address
First Line : 9605 GRAND RONDE RD
Second Line :
City : GRAND RONDE
State : OR
Zip : 97347-9712
Country : US
Telephone Number : 503-879-2002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 08/01/2024

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Directions to “ DEBORAH ANNE SAMOSON NURSE PRACTITIONER” Practice Location

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