Provider Demographics
NPI:1134765902
Name:SAUFLEY, SAMANTHA LEA (BSN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEA
Last Name:SAUFLEY
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2045 KAIOLI ST APT 2503
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6158
Mailing Address - Country:US
Mailing Address - Phone:610-999-4827
Mailing Address - Fax:
Practice Address - Street 1:91-2045 KAIOLI ST APT 2503
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6158
Practice Address - Country:US
Practice Address - Phone:610-999-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI91911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse