Provider Demographics
NPI:1356155923
Name:SAMSON, ERIC J (RN)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:SAMSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9335
Mailing Address - Country:US
Mailing Address - Phone:517-402-4283
Mailing Address - Fax:
Practice Address - Street 1:15945 WOOD RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-1746
Practice Address - Country:US
Practice Address - Phone:517-394-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704390202163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse