Provider Demographics
NPI:1295313922
Name:SAMS, DIONDRA MAXINE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:DIONDRA
Middle Name:MAXINE
Last Name:SAMS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 E DESERT COVE AVE UNIT 159
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5399
Mailing Address - Country:US
Mailing Address - Phone:347-430-0088
Mailing Address - Fax:
Practice Address - Street 1:4925 E DESERT COVE AVE
Practice Address - Street 2:UNIT 159
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5399
Practice Address - Country:US
Practice Address - Phone:347-430-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN199201163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse