Individual
SAMMANTHA JEANE KOUBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5225 23RD AVE S, FARGO, ND 58104-7927
(701) 417-2575
(701) 417-2535
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
DO-05366
IA
207RI0200X
Infectious Disease Physician
Primary
16710
ND
390200000X
Student in an Organized Health Care Education/Training Program
PG172349
OR
Other
Enumeration date
04/01/2015
Last updated
04/19/2022
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