Provider Demographics
NPI:1407189376
Name:SAMPSON, GWENDOLY IRINE (CNA)
Entity Type:Individual
Prefix:MISS
First Name:GWENDOLY
Middle Name:IRINE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 CAMPUS DR.
Mailing Address - Street 2:PRIVATE HOME
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-7726
Mailing Address - Country:US
Mailing Address - Phone:972-286-4327
Mailing Address - Fax:
Practice Address - Street 1:343 CAMPUS DR
Practice Address - Street 2:PRIVATE HOME
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-7726
Practice Address - Country:US
Practice Address - Phone:972-286-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA 08284758172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker