Samantha Bryant

Individual provider Active NPI Licensed Practical Nurse · Newark, NY

NPI 1023484649 · NPPES record last updated Aug 18, 2015

Key facts

NPI
1023484649
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
320365 (NY)
Practice address
3767 Maple Ridge Rd
Lot 92
Newark, NY 14513-9324
Phone
(585) 317-4511
NPI assigned
Aug 18, 2015
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
320365NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 320365 NY Yes

Addresses

Primary practice location

3767 Maple Ridge Rd
Lot 92
Newark, NY 14513-9324

Mailing address

3767 Maple Ridge Rd
Lot 92
Newark, NY 14513-9324
Phone (585) 317-4511

Other providers in Newark, NY

All providers in Newark, NY · Licensed Practical Nurse in New York

Sources for this page

Verify at the official NPI Registry.