Provider Demographics
NPI:1528737467
Name:DAMARE, SAMANTHA NICOLE (CNIM)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:DAMARE
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:NICOLE
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNIM
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-1945
Mailing Address - Country:US
Mailing Address - Phone:719-888-1007
Mailing Address - Fax:719-487-2689
Practice Address - Street 1:816 N FOOTE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4508
Practice Address - Country:US
Practice Address - Phone:719-888-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17-08-4794246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic