Healthcare Provider Details

I. General information

NPI: 1104656842
Provider Name (Legal Business Name): SAMANTHA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 S LOGAN ST UNIT A
DENVER CO
80209-4127
US

IV. Provider business mailing address

3020 W PRENTICE AVE UNIT H
LITTLETON CO
80123-7722
US

V. Phone/Fax

Practice location:
  • Phone: 303-733-3764
  • Fax:
Mailing address:
  • Phone: 518-423-2473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024030392
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: