MEDICARE: SAMANTHA DESENBERG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN.0994188-NP	CO
2	363LA2200X	Adult Health Nurse Practitioner	APN.0994188-NP	CO

General Provider Information

NPI Number	:	1326598210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA DESENBERG NP

Provider Business Mailing Address
First Line	:	3744 S TIMERLINE RD, STE 102
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4333
Country	:	US
Telephone Number	:	970-495-0506
Fax Number	:

Provider Business Practice Location Address
First Line	:	3744 S TIMBERLINE RD STE 102
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4334
Country	:	US
Telephone Number	:	970-495-0506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	06/10/2020

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