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Individual

SAMBATH CHEATH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP-C

Contact information

Practice address
707 LUNDORFF DR STE 1, SANDSTONE, MN 55072-5099
(320) 245-2250
(320) 245-2555
Mailing address
4570 CTY. HWY. 61, MOOSE LAKE, MN 55767-9401
(218) 485-4491
(218) 485-4724

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
6513
MN
363LF0000X
Family Nurse Practitioner
Primary
6513
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6513
CNP
MN
Enumeration date
04/09/2019
Last updated
07/12/2019
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