Provider Demographics
NPI:1508529504
Name:DALESSIO, SAMANTHA PATRICIA (RN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PATRICIA
Last Name:DALESSIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 W MARK LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7678
Mailing Address - Country:US
Mailing Address - Phone:623-249-9096
Mailing Address - Fax:
Practice Address - Street 1:6410 W MARK LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-7678
Practice Address - Country:US
Practice Address - Phone:623-249-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-16
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN215995163W00000X
AZ270749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse