Provider Demographics
NPI:1154693190
Name:SAMPSON, ERICA (CRNA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79434
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0434
Mailing Address - Country:US
Mailing Address - Phone:757-591-2260
Mailing Address - Fax:757-595-2001
Practice Address - Street 1:760 PILOT HOUSE DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2068
Practice Address - Country:US
Practice Address - Phone:757-591-2260
Practice Address - Fax:757-595-2001
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169881367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered