Doctor Name: | MRS. KEENA S SAMUELS |
NPI Number: | 1184949620 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ANP |
License Number: | 305351 |
Business Practice Address: | 20507 Hillside Ave Suite #28 Hollis, NY - 114232222 |
Business Phone Number: | 9175741655 |
Business Fax Number: | |
Mailing Address: | 20507 Hillside Ave, Suite #28 HOLLIS |
State: | NY |
Postal Code: | 114232222 |
Phone Number: | 9175741655 |
Fax Number: | |
NPI Enumeration Date: | 03/27/2010 |
NPI Last Update Date: | 01/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 305351 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |