Basic Information
| Provider Information | |||||||||
| NPI: | 1871265306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEHRELS | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | AGPCNP- BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 916 S MAIN ST UNIT 208 | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805016617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444552747 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6750 W 52ND AVE | ||||||||
| Address2: | |||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800023928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033290870 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2021 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | APN.0996954-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.