Individual
MARY ANDELLE SAMSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
21 GRAND ST, HARTFORD, CT 06106-1541
(860) 550-7500
(860) 241-0890
Mailing address
21 GRAND ST, HARTFORD, CT 06106-1541
(860) 550-7500
(860) 241-0890
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R173837
MD
363LA2100X
Acute Care Nurse Practitioner
3516
CT
363LA2200X
Adult Health Nurse Practitioner
3516
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013358200
—
CT
Enumeration date
05/11/2007
Last updated
09/29/2022
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