Provider Demographics
NPI:1457316424
Name:SAMAYOA, KERRIE H (RN, CNP)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:H
Last Name:SAMAYOA
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 COLBORNE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3228
Mailing Address - Country:US
Mailing Address - Phone:651-767-8380
Mailing Address - Fax:651-228-3649
Practice Address - Street 1:360 COLBORNE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3228
Practice Address - Country:US
Practice Address - Phone:651-767-8380
Practice Address - Fax:651-228-3649
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-136590-6363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics