Provider Demographics
NPI:1669836607
Name:WARREN, SAMANTHIA LOU (RN)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHIA
Middle Name:LOU
Last Name:WARREN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:823 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3925
Mailing Address - Country:US
Mailing Address - Phone:208-736-2177
Mailing Address - Fax:208-736-2113
Practice Address - Street 1:823 HARRISON ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3925
Practice Address - Country:US
Practice Address - Phone:208-736-2177
Practice Address - Fax:208-736-2113
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN24948251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health