Provider Demographics
NPI:1003561945
Name:POWELL, SAMANTHA L (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:POWELL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25127 CORTE DE LOS PAJAROS
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5203
Mailing Address - Country:US
Mailing Address - Phone:951-594-8361
Mailing Address - Fax:
Practice Address - Street 1:25127 CORTE DE LOS PAJAROS
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5203
Practice Address - Country:US
Practice Address - Phone:951-594-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026794163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant