Individual
SAMANTHA DANAE FUGETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5023 NE KILLINGSWORTH ST, PORTLAND, OR 97218-1915
(503) 402-8117
Mailing address
21005 SW ROSEDALE RD, ALOHA, OR 97007-8797
(417) 861-1524
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
02/11/2008
Last updated
02/11/2008
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