1366924789 NPI number — MRS. SAMANTHA MARIE DEGREGORIO RN, CRNA, DNP

Table of content: MRS. SAMANTHA MARIE DEGREGORIO RN, CRNA, DNP (NPI 1366924789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366924789 NPI number — MRS. SAMANTHA MARIE DEGREGORIO RN, CRNA, DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGREGORIO
Provider First Name:
SAMANTHA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CRNA, DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOFMANN
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366924789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 SES DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-945-5606
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2460 CURTIS ELLIS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-962-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  258637 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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