Provider Demographics
NPI:1174644157
Name:SCHIMELPFENIG, SAMRANG SUON (NP)
Entity Type:Individual
Prefix:MRS
First Name:SAMRANG
Middle Name:SUON
Last Name:SCHIMELPFENIG
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 1:4660 EL CAJON BLVD
Mailing Address - Street 2:212
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4450
Mailing Address - Country:US
Mailing Address - Phone:619-563-4040
Mailing Address - Fax:
Practice Address - Street 1:4660 EL CAJON BLVD
Practice Address - Street 2:212
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4450
Practice Address - Country:US
Practice Address - Phone:619-563-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504773164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse