Healthcare Provider Details

I. General information

NPI: 1508357112
Provider Name (Legal Business Name): SAMANTHA C STERN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9195 GRANT ST STE 130
THORNTON CO
80229-4348
US

IV. Provider business mailing address

8366 W WOODARD DR
LAKEWOOD CO
80227-2446
US

V. Phone/Fax

Practice location:
  • Phone: 844-455-2747
  • Fax:
Mailing address:
  • Phone: 262-617-9952
  • Fax: 530-541-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA55732
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0007755
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: