Provider Demographics
NPI:1184755191
Name:ANTONS, SAMRA LEE (RNFA)
Entity type:Individual
Prefix:MS
First Name:SAMRA
Middle Name:LEE
Last Name:ANTONS
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 DEEMER RD APT 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6724
Mailing Address - Country:US
Mailing Address - Phone:360-527-0789
Mailing Address - Fax:360-527-0789
Practice Address - Street 1:4156 DEEMER RD APT 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6724
Practice Address - Country:US
Practice Address - Phone:360-527-0789
Practice Address - Fax:360-527-0789
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00117445163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant