Provider Demographics
NPI:1053676304
Name:SAMSON, ASHLEY N
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:SAMSON
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 1:6920 ELM ST
Mailing Address - Street 2:
Mailing Address - City:E FULTONHAM
Mailing Address - State:OH
Mailing Address - Zip Code:43735
Mailing Address - Country:US
Mailing Address - Phone:740-408-6094
Mailing Address - Fax:
Practice Address - Street 1:32 POPLAR DR
Practice Address - Street 2:
Practice Address - City:SOUTH ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6322
Practice Address - Country:US
Practice Address - Phone:740-408-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN116682164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse