Provider Demographics
NPI:1104117464
Name:SAMS, JODELL CAREY (RNFA)
Entity type:Individual
Prefix:
First Name:JODELL
Middle Name:CAREY
Last Name:SAMS
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1202
Mailing Address - Country:US
Mailing Address - Phone:719-240-2008
Mailing Address - Fax:
Practice Address - Street 1:2911 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1202
Practice Address - Country:US
Practice Address - Phone:719-240-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO129592163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant