Provider Demographics
NPI:1770243719
Name:SANDS, SAMANTHA NEEVIE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:NEEVIE
Last Name:SANDS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BOW ST STE C
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-2300
Mailing Address - Country:US
Mailing Address - Phone:910-849-9221
Mailing Address - Fax:
Practice Address - Street 1:154 BOW ST STE C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-2300
Practice Address - Country:US
Practice Address - Phone:910-849-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC264036367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife