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Individual

SAMANTHA LAYNE HANNA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, LAT, ATC

Contact information

Practice address
875 PERIMETER DRIVE COLLEGE OF EDUCATION 123, MOSCOW, ID 83844-0001
(904) 200-7646
Mailing address
251 SOUTHVIEW AVE APT 304, MOSCOW, ID 83843-5094
(904) 200-7646

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
661
ID

Other

Enumeration date
01/15/2020
Last updated
01/15/2020
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