Provider Demographics
NPI:1306242193
Name:GICHUKI, SAMUEL
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:GICHUKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 S POWER RD
Mailing Address - Street 2:APT. 2048
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9216
Mailing Address - Country:US
Mailing Address - Phone:480-241-6326
Mailing Address - Fax:
Practice Address - Street 1:7640 S POWER RD
Practice Address - Street 2:APT. 2048
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-9216
Practice Address - Country:US
Practice Address - Phone:480-241-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP049084164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse