Most Relevant Information
Provider Data
| NPI Number: | 1003468844 |
| Provider Name: | SAMANTHA MULLIS NNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LN0005X |
| Specialty: | Nurse Practitioner |
| License Number: | 5011980 |
Most Important Dates
| Enumeration Date: | 07/11/2019 |
| Last Updated: | 04/01/2024 |
Provider Practice Location
2500 NE NEFF RD
BEND
OR
977016015
Practice Location Phone/Fax
| Phone: | 5413824321 |
| Fax: | 5417067068 |
Provider Mailing Location
200 HAWTHORNE LN
CHARLOTTE
NC
282042515
Provider Mailing Phone/Fax
| Phone: | 7043844109 |
| Fax: |