Basic Information
| Provider Information | |||||||||
| NPI: | 1669909271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMUELSON | ||||||||
| FirstName: | ROBBIN | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 9TH ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955216249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078268633 | ||||||||
| FaxNumber: | 7078268628 | ||||||||
| Practice Location | |||||||||
| Address1: | 638 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | FERNDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077864028 | ||||||||
| FaxNumber: | 7077869029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2017 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 704851 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.