Individual provider · NPI-1

Basiru Samba

Case Manager/Care Coordinator · Bowie, MD

NPI number1548636269

StatusActive

Last updated in NPPESAug 17, 2015

Details

NPI: 1548636269
Entity type: Individual (NPI-1)
Name: Basiru Samba
Sex: Male
Sole proprietor: No
Enumeration date: Aug 17, 2015
Last updated: Aug 17, 2015

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
171M00000X	Case Manager/Care Coordinator	–	–	Yes
163W00000X	Registered Nurse	R159377	MD
163WA2000X	Registered Nurse, Administrator	R155931	MD
164W00000X	Licensed Practical Nurse	LP34564	MD
174400000X	Specialist	–	–
246Y00000X	Spec/Tech, Health Info	–	–
247200000X	Technician, Other	–	–
372500000X	Chore Provider	–	–
372600000X	Adult Companion	–	–
3747A0650X	Technician, Attendant Care Provider	–	–
374U00000X	Home Health Aide	–	–
376G00000X	Nursing Home Administrator	–	–
376J00000X	Homemaker	–	–
376K00000X	Nurse's Aide	–	–

Practice location

4802 Willes Vision Dr
Bowie, MD 20720-4671

Phone 301-284-0636 · Fax 301-542-0184

Mailing address

4802 Willes Vision Dr
Bowie, MD 20720-4671

Phone 301-284-0636 · Fax 301-542-0184

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