Individual
SAMANTHA NICOLE SOUTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2810 MAPLEWOOD AVE, WINSTON SALEM, NC 27103-4138
(336) 860-6194
(336) 860-6236
Mailing address
PO BOX 604050, CHARLOTTE, NC 28260-4050
(336) 860-6194
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5023108
NC
363LF0000X
Family Nurse Practitioner
F07250035
NC
Other
Enumeration date
07/01/2024
Last updated
04/15/2026
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