Provider Demographics
NPI:1093345571
Name:SAMUELSON, NAOMI JOY (FNP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:JOY
Last Name:SAMUELSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PLEASANT VIEW RD
Mailing Address - Street 2:
Mailing Address - City:SLAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:56172-1933
Mailing Address - Country:US
Mailing Address - Phone:507-828-1213
Mailing Address - Fax:
Practice Address - Street 1:34 PLEASANT VIEW RD
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-1933
Practice Address - Country:US
Practice Address - Phone:507-828-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily