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Individual
MRS. SAMANTHA MARIE BLACKWELL
Active
Individual
MRS. SAMANTHA MARIE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
24729
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP7493
—
SC
01
—
SCJ8335019
MEDICARE PIN
SC
Enumeration date
03/10/2021
Last updated
03/11/2024
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