Provider Demographics
NPI:1083188312
Name:MURAKAMI-SAMALA, RYANNE
Entity Type:Individual
Prefix:
First Name:RYANNE
Middle Name:
Last Name:MURAKAMI-SAMALA
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 1:3200 S LITZLER DR APT 3-109
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-8904
Mailing Address - Country:US
Mailing Address - Phone:808-753-5971
Mailing Address - Fax:
Practice Address - Street 1:3200 S LITZLER DR APT 3-109
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86005-8904
Practice Address - Country:US
Practice Address - Phone:808-753-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer