| NPI | 1346802956 |
|---|---|
| Former Name | SAMANTHA BETH SOUTHWORTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704310531) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 20186121) |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2019-08-29 |