Provider Demographics
NPI:1053718023
Name:MACDONALD, SAMANTHA JOY (RN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOY
Last Name:MACDONALD
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 1:26920 PIONEER HWY
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-9548
Mailing Address - Country:US
Mailing Address - Phone:360-629-1260
Mailing Address - Fax:
Practice Address - Street 1:26920 PIONEER HWY
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-9548
Practice Address - Country:US
Practice Address - Phone:360-629-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00162680163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool