Provider Information for 1467016261
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ANASTHASIA L. SAMSON
Sex: Female
NPI: 1467016261
Last Updated: 2019-04-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1467016261 | ||||||||
| Enumeration Date | 2019-04-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2658 CASTLE PL LA CROSSE, WI 54601-6492 United States Phone: 608-797-6327 | Fax: | ||||||||
| Primary Practice Address | 115 5TH AVE S STE 525 LA CROSSE, WI 54601-9200 United States Phone: 608-797-6327 | Fax: | ||||||||
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