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Individual

NELLIE IDARA SAMUEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, APRN,PMHNP-BC

Contact information

Practice address
2400 NORTHSIDE XING, MACON, GA 31210-2252
(865) 765-8225
Mailing address
1011 POST DRIVE, P O BOX 6250, SALINAS, CA 93912
(865) 765-8225

Taxonomy

Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
RN225022
GA
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN225022
GA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
RN225022
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
95014791
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP10318
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN225022
GA

Other

Enumeration date
07/31/2012
Last updated
12/28/2020
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