Provider Demographics
NPI:1851674097
Name:SAMPSON, HARALD JORGE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:HARALD
Middle Name:JORGE
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6952 APUWAI PL
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3513
Mailing Address - Country:US
Mailing Address - Phone:228-493-2490
Mailing Address - Fax:
Practice Address - Street 1:6952 APUWAI PL
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3513
Practice Address - Country:US
Practice Address - Phone:228-493-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR868903367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered