Provider Demographics
NPI:1609356757
Name:SAMSON, ERICKA (RN, ATC)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:SAMSON
Suffix:
Gender:F
Credentials:RN, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 BEELARD DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5809
Mailing Address - Country:US
Mailing Address - Phone:650-773-2447
Mailing Address - Fax:
Practice Address - Street 1:325 BEELARD DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5809
Practice Address - Country:US
Practice Address - Phone:650-773-2447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
CA95340484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer