Provider Demographics
NPI:1346742046
Name:WARNER, SAMANTHA RAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:RAE
Last Name:WARNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:RAE
Other - Last Name:VERMILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:179 COUNTY ROUTE 64
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114
Mailing Address - Country:US
Mailing Address - Phone:319-963-4288
Mailing Address - Fax:315-963-4316
Practice Address - Street 1:179 COUNTY ROUTE 64
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114
Practice Address - Country:US
Practice Address - Phone:319-963-4288
Practice Address - Fax:315-963-4316
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY705274163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool