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Jennifer Sample

NPI Registration Record

Provider / OrganizationNPIDate Certified
JENNIFER SAMPLE19822924962021-01-10
Entity TypeIndividual
Provider Name Jennifer Sample
Practice Office Address1300 N 17TH AVE
GREELEY, CO US
Practice Office Telephone9703472120
Mailing Address1300 N 17TH AVE
GREELEY, CO 806319584 US
Business Telephone9703472120
HPT Codes
CodeLicense NoState
390200000X PRIMARY
OPI Codes

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