Individual
SAMANTHA ROSE KHUNDMIRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, APNP
Contact information
Practice address
6220 W LOOMIS RD, GREENDALE, WI 53129-2448
(414) 423-0555
Mailing address
6220 W LOOMIS RD, GREENDALE, WI 53129-2448
(414) 423-0555
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
230241-30
WI
363LF0000X
Family Nurse Practitioner
Primary
11302-33
WI
Other
Enumeration date
03/19/2021
Last updated
09/27/2021
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