Individual
IAN SAMUELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
1005 W MARKET ST STE 7, ATHENS, AL 35611-2454
(256) 233-9273
(256) 216-9192
Mailing address
1005 W MARKET ST STE 7, ATHENS, AL 35611-2454
(256) 233-9273
(256) 216-9192
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-121085
AL
Other
Enumeration date
05/16/2014
Last updated
05/16/2014
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