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General NPI Number Information
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NPI Number | 1740474089
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Entity Type | Individual
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Provider Name | DELORES MARIE SAM M.T.
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Gender | Female
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 515 SHOSHONE CIR
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City | ELKO
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State | NV
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Zip | 89801-5072
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Country | US
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Telephone | 775-738-2252
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Fax | 775-738-4219
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Provider Business Mailing Address
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Address Line | 515 SHOSHONE CIR
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City | ELKO
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State | NV
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Zip | 89801-5072
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Country | US
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Telephone | 775-738-2252
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Fax | 775-738-4219
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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 | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number | CNA018155
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License Number State | NV
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