Provider Demographics
NPI:1740065218
Name:ANNA, SAMANTHA JANE (RN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:ANNA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6107
Mailing Address - Country:US
Mailing Address - Phone:315-525-6902
Mailing Address - Fax:
Practice Address - Street 1:48 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2337
Practice Address - Country:US
Practice Address - Phone:315-797-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY896163-01163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice