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General NPI Number Information
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NPI Number | 1992113476
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Entity Type | Organization
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Legal Business Name | SAMSAJOR LLC
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 568 N EASTERN AVE STE B
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City | LAS VEGAS
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State | NV
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Zip | 89101-3454
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Country | US
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Telephone | 702-522-7275
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Fax | 702-272-1317
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Provider Business Mailing Address
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Address Line | 568 N EASTERN AVE STE B
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City | LAS VEGAS
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State | NV
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Zip | 89101-3454
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Country | US
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Telephone | 702-522-7275
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Fax | 702-272-1317
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ETHEL SAJOR SAM
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Credential | NURSE PRACTITIONER
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Telephone | 702-522-7275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN001077
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License Number State | NV
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