Provider Demographics
NPI:1437518552
Name:FARNUM, SAMANTHA AUGUSTA (APRN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:AUGUSTA
Last Name:FARNUM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 CENTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-3428
Mailing Address - Country:US
Mailing Address - Phone:507-238-4968
Mailing Address - Fax:
Practice Address - Street 1:1950 CENTER CREEK DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-3428
Practice Address - Country:US
Practice Address - Phone:507-238-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP4398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily