Provider Demographics
NPI:1225786841
Name:RANDALL, SAMANTHA MARIE (RN)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:RANDALL
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 1:711 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3154
Mailing Address - Country:US
Mailing Address - Phone:315-281-7841
Mailing Address - Fax:
Practice Address - Street 1:1001 RUBY ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2565
Practice Address - Country:US
Practice Address - Phone:315-338-5360
Practice Address - Fax:315-334-7528
Is Sole Proprietor?:No
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY804401163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool