Provider Demographics
NPI:1134546963
Name:WOOLSEY, SAMANTHA (RN)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:
Last Name:WOOLSEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W ROOSEVELT ST
Mailing Address - Street 2:APT. # 16
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1330
Mailing Address - Country:US
Mailing Address - Phone:928-451-0454
Mailing Address - Fax:
Practice Address - Street 1:526 W ROOSEVELT ST
Practice Address - Street 2:APT. # 16
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1330
Practice Address - Country:US
Practice Address - Phone:928-451-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN183545163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse