Healthcare Provider Details

I. General information

NPI: 1689195661
Provider Name (Legal Business Name): ROSE L SAMS RN, CNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 GOODYEAR BLVD
AKRON OH
44305-2919
US

IV. Provider business mailing address

1148 MONTERAY DR
AKRON OH
44305-1770
US

V. Phone/Fax

Practice location:
  • Phone: 330-475-9160
  • Fax: 330-733-9786
Mailing address:
  • Phone: 330-475-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN274476
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: