Individual
SAMANTHA LEE KINNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4448 W LOOMIS RD, GREENFIELD, WI 53220-4800
(414) 281-5150
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7755
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100273671
—
WI
Enumeration date
12/04/2023
Last updated
06/12/2024
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