Provider Demographics
NPI:1992275564
Name:SAMPSON, MARILYN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 N ANKENY BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4611
Mailing Address - Country:US
Mailing Address - Phone:515-294-4600
Mailing Address - Fax:515-965-5642
Practice Address - Street 1:3625 N ANKENY BLVD STE F
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4611
Practice Address - Country:US
Practice Address - Phone:515-964-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant