Provider Demographics
NPI:1487898714
Name:SAM, VERONICA N
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:N
Last Name:SAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 FAWN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5213
Mailing Address - Country:US
Mailing Address - Phone:972-658-5682
Mailing Address - Fax:972-359-7444
Practice Address - Street 1:717 FAWN VALLEY DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-5213
Practice Address - Country:US
Practice Address - Phone:972-658-5682
Practice Address - Fax:972-359-7444
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator