Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 110585 | NE |
NPI | 1053307306 |
---|---|
Provider Name | Courtney B Sams |
First Address | Lincoln, NE 68510-2229 |
Second Address | Lincoln, NE 68510-2229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 13/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47055126013 | (05) | NE |
Q04727 | (02) |