Provider Demographics
NPI:1942872379
Name:VENN, SAMANTHA MAE (CPM, RM)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MAE
Last Name:VENN
Suffix:
Gender:F
Credentials:CPM, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12513 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-4600
Mailing Address - Country:US
Mailing Address - Phone:303-324-8636
Mailing Address - Fax:
Practice Address - Street 1:2201 KIPLING ST STE 201
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1545
Practice Address - Country:US
Practice Address - Phone:303-324-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMWR.0000202176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMWR.0000202OtherCOLORADO STATE LICENSE NUMBER