Provider Demographics
NPI:1093117608
Name:SAMUDA, GARNETT LIVINGSTONE (LPN)
Entity Type:Individual
Prefix:MR
First Name:GARNETT
Middle Name:LIVINGSTONE
Last Name:SAMUDA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15109 JENNINGS LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7208
Mailing Address - Country:US
Mailing Address - Phone:301-221-9642
Mailing Address - Fax:
Practice Address - Street 1:15109 JENNINGS LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-7208
Practice Address - Country:US
Practice Address - Phone:301-221-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1006165164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse