Provider Demographics
NPI:1467737981
Name:SAMSON, JOSEPHINE SANTIAGO (LPN)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:SANTIAGO
Last Name:SAMSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BILTMORE CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1475
Mailing Address - Country:US
Mailing Address - Phone:917-587-4946
Mailing Address - Fax:
Practice Address - Street 1:16 BILTMORE CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1475
Practice Address - Country:US
Practice Address - Phone:917-587-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296869164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse