Provider Demographics
NPI:1235988940
Name:LEICESTER, SAMARA ALEXUS (FAMILY NP)
Entity type:Individual
Prefix:
First Name:SAMARA
Middle Name:ALEXUS
Last Name:LEICESTER
Suffix:
Gender:F
Credentials:FAMILY NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4597
Mailing Address - Country:US
Mailing Address - Phone:303-739-1211
Mailing Address - Fax:303-602-4560
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4597
Practice Address - Country:US
Practice Address - Phone:303-739-1211
Practice Address - Fax:303-602-4560
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999607-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily