Provider Demographics
NPI:1255358867
Name:SAMS, CAROL J (CNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:SAMS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SOM CENTER RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2350
Mailing Address - Country:US
Mailing Address - Phone:440-720-3230
Mailing Address - Fax:216-201-7205
Practice Address - Street 1:730 SOM CENTER RD
Practice Address - Street 2:SUITE 240
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2350
Practice Address - Country:US
Practice Address - Phone:440-720-3230
Practice Address - Fax:216-201-7205
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP4816363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2125819Medicaid
OHS86902Medicare UPIN
OHSANP75661Medicare ID - Type Unspecified