Provider Demographics
NPI:1215719851
Name:WILSON, SAMANTHA (BCHHP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:BCHHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347736 E 890 RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-7082
Mailing Address - Country:US
Mailing Address - Phone:405-385-3433
Mailing Address - Fax:
Practice Address - Street 1:347736 E 890 RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-7082
Practice Address - Country:US
Practice Address - Phone:405-385-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath