Provider Demographics
NPI:1033727649
Name:HEDGES, SAMANTHA ASHLEY
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ASHLEY
Last Name:HEDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MOUNTAIN LN APT 3C
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2502
Mailing Address - Country:US
Mailing Address - Phone:716-440-1428
Mailing Address - Fax:
Practice Address - Street 1:3 MOUNTAIN LN APT 3C
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2502
Practice Address - Country:US
Practice Address - Phone:716-440-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY753444163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty