Provider Demographics
NPI:1811650849
Name:SAMSON, GRACE MARIE (APRN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:SAMSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 S MARYLAND PKWY STE 2023059S
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2294
Mailing Address - Country:US
Mailing Address - Phone:702-680-1500
Mailing Address - Fax:
Practice Address - Street 1:3059 S MARYLAND PKWY STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-6209
Practice Address - Country:US
Practice Address - Phone:702-680-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV837808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily