Provider Demographics
NPI:1598211914
Name:VANN, SAMANTHA MARIE
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:VANN
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 1:2147 MOORHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1157
Mailing Address - Country:US
Mailing Address - Phone:248-862-4389
Mailing Address - Fax:
Practice Address - Street 1:2147 MOOREHOUSE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220
Practice Address - Country:US
Practice Address - Phone:248-862-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other