Provider Demographics
NPI:1326212192
Name:CONNAUGHTY, SAMANTHA SUE (RN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SUE
Last Name:CONNAUGHTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 MEIER LN
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-9088
Mailing Address - Country:US
Mailing Address - Phone:608-317-9909
Mailing Address - Fax:
Practice Address - Street 1:626 MEIER LN
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-9088
Practice Address - Country:US
Practice Address - Phone:608-317-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health