Provider Demographics
NPI:1508357112
Name:STERN, SAMANTHA C (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:C
Last Name:STERN
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:8366 W WOODARD DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2446
Mailing Address - Country:US
Mailing Address - Phone:262-617-9952
Mailing Address - Fax:530-541-8723
Practice Address - Street 1:9195 GRANT ST STE 130
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4348
Practice Address - Country:US
Practice Address - Phone:844-455-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA55732363A00000X
CO0007755363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant