Basic Information
| Provider Information | |||||||||
| NPI: | 1700304334 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAVINSKI | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | PRZYBYLEK | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19500 10TH AVE NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983706331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605987500 | ||||||||
| FaxNumber: | 2539446986 | ||||||||
| Practice Location | |||||||||
| Address1: | 19500 10TH AVE NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983706331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605987500 | ||||||||
| FaxNumber: | 2539446986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2017 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | AP60783140 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363L00000X | AP60783140 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 2088711 | 05 | WA | MEDICAID |