Individual
MRS. SAMANTHA J VAN GINNEKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5320 S RAINBOW BLVD STE 150, LAS VEGAS, NV 89118-1807
(702) 944-7105
(702) 944-7110
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1294
NV
363AM0700X
Medical Physician Assistant
PA 1294
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225315229
—
NV
01
—
PA1294
STATE LICENSE
NV
Enumeration date
11/04/2011
Last updated
10/20/2022
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