Provider Demographics
NPI:1033776133
Name:PAUL SAMUELSON PMHNP-BC, INC
Entity Type:Organization
Organization Name:PAUL SAMUELSON PMHNP-BC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CERNY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:805-448-5292
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-1251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:919 3RD ST STE 204A
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-9228
Practice Address - Country:US
Practice Address - Phone:360-205-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty