Healthcare Provider Details

I. General information

NPI: 1437332889
Provider Name (Legal Business Name): DEBORAH SAMS RN, PHN, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH SAMS-USATIN

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 CENTER AVE 200A
MARTINEZ CA
94553-4640
US

IV. Provider business mailing address

440 BRIDGE RD
WALNUT CREEK CA
94595-1325
US

V. Phone/Fax

Practice location:
  • Phone: 925-313-6615
  • Fax: 925-313-6465
Mailing address:
  • Phone: 925-313-6615
  • Fax: 925-313-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number266584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: