Provider Demographics
NPI:1689195661
Name:SAMS, ROSE L (RN, CNT)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:L
Last Name:SAMS
Suffix:
Gender:F
Credentials:RN, CNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 MONTERAY DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-1770
Mailing Address - Country:US
Mailing Address - Phone:330-475-9160
Mailing Address - Fax:
Practice Address - Street 1:1750 GOODYEAR BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-2919
Practice Address - Country:US
Practice Address - Phone:330-475-9160
Practice Address - Fax:330-733-9786
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN274476163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult