Provider Demographics
NPI:1659567584
Name:SAMUELS, JENNIFER LYNN (NP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:260 S KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1086
Mailing Address - Country:US
Mailing Address - Phone:303-239-7106
Mailing Address - Fax:303-239-7157
Practice Address - Street 1:260 S KIPLING ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1086
Practice Address - Country:US
Practice Address - Phone:303-239-7106
Practice Address - Fax:303-239-7157
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0005727-NP364SA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health