Provider Demographics
NPI:1407950553
Name:YUKNE, SAMANTHA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:YUKNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:LYNN
Other - Last Name:DOMINGUES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:5648 W PIERSON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9201 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3332
Practice Address - Country:US
Practice Address - Phone:623-327-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP030079164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse