Healthcare Provider Details

I. General information

NPI: 1063714640
Provider Name (Legal Business Name): KIMBERLY SAMMAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 SOUTH FIFTH ST.
ODESSA DE
19730-4010
US

IV. Provider business mailing address

P.O. BOX 4010 313 SOUTH FIFTH ST.
ODESSA DE
19730-4010
US

V. Phone/Fax

Practice location:
  • Phone: 302-376-4128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL1-0023880
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: