Provider Demographics
NPI:1780643544
Name:SAMPLES, NANCY S (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:SAMPLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 EDISON ST
Mailing Address - Street 2:STE. A
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723-2436
Mailing Address - Country:US
Mailing Address - Phone:970-842-5010
Mailing Address - Fax:970-842-4120
Practice Address - Street 1:1224 EDISON ST
Practice Address - Street 2:STE. A
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723-2436
Practice Address - Country:US
Practice Address - Phone:970-842-5010
Practice Address - Fax:970-842-4120
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCORN63639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
550058Medicare ID - Type Unspecified
S81768Medicare UPIN