Provider Demographics
NPI:1972216596
Name:OWENS, SAMANTHA R
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:OWENS
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 1:705 SCENIC LN
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6917
Mailing Address - Country:US
Mailing Address - Phone:845-489-2046
Mailing Address - Fax:
Practice Address - Street 1:705 SCENIC LN
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6917
Practice Address - Country:US
Practice Address - Phone:845-489-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist