Provider Demographics
NPI:1346823234
Name:SAMUEL, ATASKA YVETTE I
Entity Type:Individual
Prefix:
First Name:ATASKA
Middle Name:YVETTE
Last Name:SAMUEL
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15503 STEEL ST # 1
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-4033
Mailing Address - Country:US
Mailing Address - Phone:248-993-3206
Mailing Address - Fax:
Practice Address - Street 1:15503 STEEL ST # 1
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-4033
Practice Address - Country:US
Practice Address - Phone:248-993-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230009433390504251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care