Provider Demographics
NPI:1558093096
Name:SAMORA, MARK ALLYN (RN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLYN
Last Name:SAMORA
Suffix:
Gender:M
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:C/O QUALITY WOUND CARE, INC., ONE WESTBROOK CORPORATE C
Mailing Address - Street 2:300
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154
Mailing Address - Country:US
Mailing Address - Phone:630-881-3250
Mailing Address - Fax:
Practice Address - Street 1:C/O QUALITY WOUND CARE, INC., ONE WESTBROOK CORPORATE C
Practice Address - Street 2:300
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154
Practice Address - Country:US
Practice Address - Phone:630-881-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.355949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse