Basic Information
| Provider Information | |||||||||
| NPI: | 1821722943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE VERA | ||||||||
| FirstName: | SAMANTHA CHANEL | ||||||||
| MiddleName: | BARBOSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2421 ANQUA DR | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894342236 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 235 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757703000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2022 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | RN89299 | NV | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LA2200X | 857646 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.