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General NPI Number Information
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NPI Number | 1053819755
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Entity Type | Individual
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Provider Name | IMELDA CHI SAM NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/28/2018
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 3968 N RANCHO DR
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City | LAS VEGAS
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State | NV
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Zip | 89130-3412
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Country | US
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Telephone | 702-791-9020
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Fax | 702-791-9261
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Provider Business Mailing Address
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Address Line | 6900 N PECOS RD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89086-4400
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Country | US
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Telephone | 702-791-9000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN00002763
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN002763
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License Number State | NV
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