Provider Demographics
NPI:1134480957
Name:SAMU, KRISTINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:SAMU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 N HURON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3296
Mailing Address - Country:US
Mailing Address - Phone:734-896-4112
Mailing Address - Fax:734-896-4113
Practice Address - Street 1:1065 N HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3296
Practice Address - Country:US
Practice Address - Phone:734-896-4112
Practice Address - Fax:734-896-4113
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263263363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner