Provider Demographics
NPI:1073169207
Name:SAMSON, HALEY QUINN (RN)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:QUINN
Last Name:SAMSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CRESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2914
Mailing Address - Country:US
Mailing Address - Phone:269-779-8627
Mailing Address - Fax:
Practice Address - Street 1:1910 SHAFFER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1604
Practice Address - Country:US
Practice Address - Phone:269-382-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704330360163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse