Individual
SAMANTHA POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16205 W HEATHERLY DR, NEW BERLIN, WI 53151-9236
(262) 353-2424
Mailing address
16205 W HEATHERLY DR, NEW BERLIN, WI 53151-9236
(262) 353-2424
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/01/2022
Last updated
07/01/2022
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