Provider Demographics
NPI:1689003634
Name:WEBER, SAMANTHA LEAH (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEAH
Last Name:WEBER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2145
Mailing Address - Country:US
Mailing Address - Phone:619-997-2995
Mailing Address - Fax:
Practice Address - Street 1:3604 GARRISON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2145
Practice Address - Country:US
Practice Address - Phone:619-997-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-09
Last Update Date:2013-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95021894363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health