Provider Demographics
NPI:1205609013
Name:KRAFT, SAMANTHA ALISE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALISE
Last Name:KRAFT
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 1:2012 43RD AVE E # 18
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-2752
Mailing Address - Country:US
Mailing Address - Phone:651-303-9902
Mailing Address - Fax:
Practice Address - Street 1:400 23RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6025
Practice Address - Country:US
Practice Address - Phone:206-252-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61473300163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool