Individual
SAMANTHA BUKOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2525 CHICAGO AVE, MINNEAPOLIS, MN 55404-4518
(612) 813-6000
Mailing address
100 E 77TH ST, NEW YORK, NY 10075-1850
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NY
Other
Enumeration date
10/07/2021
Last updated
12/08/2024
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