Individual
DIANE M SAMELAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
300150
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10057680
—
VA
05
—
7000933
—
NC
01
—
7883693
AETNA
—
01
—
C4802
MEDCOST
—
Enumeration date
12/20/2005
Last updated
12/27/2007
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