Healthcare Provider Details

I. General information

NPI: 1659286094
Provider Name (Legal Business Name): DELIDA SAMONE SAM LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 E EXPOSITION AVE
AURORA CO
80012-2542
US

IV. Provider business mailing address

8444 N 90TH ST STE 100
SCOTTSDALE AZ
85258-4437
US

V. Phone/Fax

Practice location:
  • Phone: 720-853-4230
  • Fax: 303-745-4832
Mailing address:
  • Phone: 602-248-8889
  • Fax: 602-248-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP014962
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: