Individual
SAMANTHA DANIELLE KISAMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12 MAPLE HILL AVE STE 1, PETERSBURG, WV 26847-1547
(304) 257-9298
Mailing address
12 MAPLE HILL AVE STE 1, PETERSBURG, WV 26847-1547
(304) 257-9298
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
80681
WV
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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