Provider Demographics
NPI:1689009367
Name:SANTUCCIO, SAMANTHA LEA (LVN)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:LEA
Last Name:SANTUCCIO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 BLAKESLEE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521
Mailing Address - Country:US
Mailing Address - Phone:530-864-2825
Mailing Address - Fax:
Practice Address - Street 1:1856 BLAKESLEE AVE
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5417
Practice Address - Country:US
Practice Address - Phone:530-864-2825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274579164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse