MEDICARE: CAROL J SAMS CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP4816	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255358867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL J SAMS CNP

Provider Business Mailing Address
First Line	:	730 SOM CENTER RD
Second Line	:	SUITE 240
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2350
Country	:	US
Telephone Number	:	440-720-3230
Fax Number	:	216-201-7205

Provider Business Practice Location Address
First Line	:	730 SOM CENTER RD
Second Line	:	SUITE 240
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2350
Country	:	US
Telephone Number	:	440-720-3230
Fax Number	:	216-201-7205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/01/2017

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