Provider Demographics
NPI:1568123263
Name:SAMPSON, PRISCILLA ANN
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 HOLBROOK ST NE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2939
Mailing Address - Country:US
Mailing Address - Phone:202-718-6857
Mailing Address - Fax:
Practice Address - Street 1:2310 18TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3629
Practice Address - Country:US
Practice Address - Phone:202-345-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide