Provider Demographics
NPI:1407648306
Name:GONZALEZ, SAMANTHA STEPHANIE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:STEPHANIE
Last Name:GONZALEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MARGIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5208
Mailing Address - Country:US
Mailing Address - Phone:978-476-3862
Mailing Address - Fax:
Practice Address - Street 1:38 MARGIN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-5208
Practice Address - Country:US
Practice Address - Phone:978-476-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2386698163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty