Individual
SAMANTHA WHITACRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
(651) 982-7000
Mailing address
504 MOLINE LOOP NW, ISANTI, MN 55040-6515
(320) 249-7938
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
214538-7
MN
Other
Enumeration date
09/03/2014
Last updated
09/03/2014
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