Provider Demographics
NPI:1013625847
Name:DAVISON, SAMANTHA MARIE HARRIS (ND)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MARIE HARRIS
Last Name:DAVISON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 PELICAN PL
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-4701
Mailing Address - Country:US
Mailing Address - Phone:701-471-7597
Mailing Address - Fax:
Practice Address - Street 1:311 N MANDAN ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3859
Practice Address - Country:US
Practice Address - Phone:701-751-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2022-04175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath