Provider Demographics
NPI:1598089336
Name:SAMBERGEROVA, PETRA SHAMA (CCCE, CLD, CLE)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:SHAMA
Last Name:SAMBERGEROVA
Suffix:
Gender:F
Credentials:CCCE, CLD, CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1324
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-1324
Mailing Address - Country:US
Mailing Address - Phone:970-390-7754
Mailing Address - Fax:970-748-0618
Practice Address - Street 1:181 WEST MEADOW DRIVE
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657
Practice Address - Country:US
Practice Address - Phone:970-479-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula