Provider Demographics
NPI:1003644493
Name:DAKON, SAMANTHA ANDREA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANDREA
Last Name:DAKON
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 1:197 GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:TUNNELTON
Mailing Address - State:WV
Mailing Address - Zip Code:26444-7793
Mailing Address - Country:US
Mailing Address - Phone:304-698-3069
Mailing Address - Fax:
Practice Address - Street 1:197 GIBSON ST
Practice Address - Street 2:
Practice Address - City:TUNNELTON
Practice Address - State:WV
Practice Address - Zip Code:26444-7793
Practice Address - Country:US
Practice Address - Phone:304-698-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant