Provider Demographics
NPI:1568206175
Name:SAMOURA, FATOUMATA BINTA (RN)
Entity type:Individual
Prefix:
First Name:FATOUMATA
Middle Name:BINTA
Last Name:SAMOURA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W MARKET ST UNIT 42
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2865
Mailing Address - Country:US
Mailing Address - Phone:484-288-9045
Mailing Address - Fax:
Practice Address - Street 1:121 MAYFIELD DR
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3070
Practice Address - Country:US
Practice Address - Phone:484-288-9045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN745793163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse