Provider Demographics
NPI:1336593847
Name:HALVORSEN, SAMANTHA (BSC, OD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:HALVORSEN
Suffix:
Gender:
Credentials:BSC, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 45 AVENUE
Mailing Address - Street 2:
Mailing Address - City:CAMROSE
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T4V 0C2
Mailing Address - Country:CA
Mailing Address - Phone:787-222-1414
Mailing Address - Fax:
Practice Address - Street 1:1851 SIROCCO DR SW
Practice Address - Street 2:UNIT 505
Practice Address - City:CALGARY
Practice Address - State:ALBERTA
Practice Address - Zip Code:T3H4R5
Practice Address - Country:CA
Practice Address - Phone:403-685-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program