Provider Demographics
NPI:1508967936
Name:SAMOYLENKO, ELIZABETH (RN MSN FNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:SAMOYLENKO
Suffix:
Gender:F
Credentials:RN MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277
Mailing Address - Country:US
Mailing Address - Phone:559-732-4662
Mailing Address - Fax:559-636-2733
Practice Address - Street 1:431 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-732-4662
Practice Address - Fax:559-636-2733
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16468363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner