Provider Demographics
NPI:1376315523
Name:KEWIN, SAMANTHA (PMHNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KEWIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5642 34TH ST
Mailing Address - Street 2:
Mailing Address - City:ELK MOUND
Mailing Address - State:WI
Mailing Address - Zip Code:54739-4134
Mailing Address - Country:US
Mailing Address - Phone:171-522-2183
Mailing Address - Fax:
Practice Address - Street 1:5642 34TH ST
Practice Address - Street 2:
Practice Address - City:ELK MOUND
Practice Address - State:WI
Practice Address - Zip Code:54739-4134
Practice Address - Country:US
Practice Address - Phone:715-222-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229157163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse