Individual
SUSAMMA SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
221 W COLORADO BLVD STE 525, DALLAS, TX 75208-2312
(214) 960-5681
Mailing address
PO BOX 845347, DALLAS, TX 75284-7208
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP140870
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
AP140870
TX
Other
Enumeration date
07/15/2019
Last updated
02/14/2022
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