Individual
SAMANTHA DIANE DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
5225 23RD AVE S, FARGO, ND 58104-7927
(701) 417-2575
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
95063542
CA
163WM0705X
Medical-Surgical Registered Nurse
R042508
SD
363L00000X
Nurse Practitioner
Primary
R49889
ND
363LF0000X
Family Nurse Practitioner
R49889
ND
Other
Enumeration date
11/21/2020
Last updated
08/06/2021
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