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SAMANTHA JO DATES

>> Licensed Practical Nurse >> Nursing Service Providers

Registrant NPI Number: 1538767355

Individual Registrant:
 SAMANTHA JO DATES 
Gender: F
Not Sole Proprietor

Location and contact information for practice:
N8273 E FRIESLAND RD  RANDOLPH, WI 53956-9407 US
Tel: 920-296-7067  Fax: --

Contact information for business:
N8273 E FRIESLAND RD  RANDOLPH, WI 53956-9407 US
Tel: 920-296-7067  Fax: --

Registration Information:
NPI: 1538767355
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y164W00000XNursing Service Providers
Licensed Practical Nurse
WI325608

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS WI - Page 1



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