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General NPI Number Information
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NPI Number | 1568298495
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Entity Type | Individual
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Provider Name | SAMANTHA MAE BORT REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 2525 S DOWNING ST
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City | DENVER
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State | CO
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Zip | 80210-5817
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Country | US
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Telephone | 303-778-5871
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Fax |
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Provider Business Mailing Address
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Address Line | 3033 COOL MEADOW PL
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City | CASTLE ROCK
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State | CO
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Zip | 80104-3370
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Country | US
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Telephone | 303-921-2414
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 1679808
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License Number State | CO
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