Provider Demographics
NPI:1215586631
Name:BLAIR, SAMANTHA PAIGE (RN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PAIGE
Last Name:BLAIR
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 1:1017 COUNTY ROAD 913
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-4717
Mailing Address - Country:US
Mailing Address - Phone:214-502-3958
Mailing Address - Fax:
Practice Address - Street 1:1017 COUNTY ROAD 913
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-4717
Practice Address - Country:US
Practice Address - Phone:214-502-3958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX961230163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse