Provider Demographics
NPI:1386466985
Name:SAMSON, AMY GREEN (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:GREEN
Last Name:SAMSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SUE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2412 ODENDRON CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6618
Mailing Address - Country:US
Mailing Address - Phone:804-651-5145
Mailing Address - Fax:
Practice Address - Street 1:2412 ODENDRON CT
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-6618
Practice Address - Country:US
Practice Address - Phone:804-651-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001169455163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse