Doctor Name: | MS. JEANNIE RAY SAMUEL |
NPI Number: | 1467719807 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PNP-BC |
License Number: | 95003356 |
Business Practice Address: | 8787 Hall Rd Lamont, CA - 932411953 |
Business Phone Number: | 6618453731 |
Business Fax Number: | 6618451157 |
Mailing Address: | Po Box 1559, BAKERSFIELD |
State: | CA |
Postal Code: | 933021559 |
Phone Number: | 6616353050 |
Fax Number: | 6613261347 |
NPI Enumeration Date: | 04/23/2012 |
NPI Last Update Date: | 11/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 95003356 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |