Provider Demographics
NPI:1689370686
Name:SIMPSON UTER, SAMANTA M S
Entity Type:Individual
Prefix:MRS
First Name:SAMANTA
Middle Name:M S
Last Name:SIMPSON UTER
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 1:25543 147TH DR
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2838
Mailing Address - Country:US
Mailing Address - Phone:347-303-3048
Mailing Address - Fax:
Practice Address - Street 1:25543 147TH DR
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2838
Practice Address - Country:US
Practice Address - Phone:347-303-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346092-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse