Provider Demographics
NPI:1427457365
Name:TAYLOR, SAMANTHA H (RN, LMT, BCTMB)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:H
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN, LMT, BCTMB
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 771326
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-1326
Mailing Address - Country:US
Mailing Address - Phone:907-350-3510
Mailing Address - Fax:
Practice Address - Street 1:11723 OLD GLENN HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7748
Practice Address - Country:US
Practice Address - Phone:907-350-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNUR R 16194163WM1400X
AK101827225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist