Provider Demographics
NPI:1467732768
Name:VAN BEEK, SAMANTHA LEE (LPN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:VAN BEEK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 HIGHWAY 61 WEST
Mailing Address - Street 2:
Mailing Address - City:GOODVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55987-1659
Mailing Address - Country:US
Mailing Address - Phone:507-410-1144
Mailing Address - Fax:507-410-1144
Practice Address - Street 1:4465 HIGHWAY 61 WEST
Practice Address - Street 2:
Practice Address - City:GOODVIEW
Practice Address - State:MN
Practice Address - Zip Code:55987-1659
Practice Address - Country:US
Practice Address - Phone:507-410-1144
Practice Address - Fax:507-410-1144
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL672470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse