Provider Demographics
NPI:1477336642
Name:RAY, SAMALA ROSE (LVN)
Entity Type:Individual
Prefix:MS
First Name:SAMALA
Middle Name:ROSE
Last Name:RAY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5336
Mailing Address - Country:US
Mailing Address - Phone:707-601-1122
Mailing Address - Fax:
Practice Address - Street 1:2107 1ST ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0840
Practice Address - Country:US
Practice Address - Phone:707-273-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690008164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse