Provider Demographics
NPI:1780040626
Name:INDINO, SAMUEL WINSTON ALVARICO JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL WINSTON
Middle Name:ALVARICO
Last Name:INDINO
Suffix:JR
Gender:M
Credentials:LPN
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Mailing Address - Street 1:9040 REID STREET, ATTN:MCHJ-CLQ-C
Mailing Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-1110
Mailing Address - Fax:877-874-1031
Practice Address - Street 1:9040 REID STREET, ATTN:MCHJ-CLQ-C
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:877-874-1031
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
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Provider Licenses
StateLicense IDTaxonomies
WALP00057744164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse