Provider Demographics
NPI:1477559565
Name:SAMUELSON, NANCY V
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:V
Last Name:SAMUELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381-4504
Mailing Address - Country:US
Mailing Address - Phone:320-239-4361
Mailing Address - Fax:
Practice Address - Street 1:118 WEST 5TH ST
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381-0399
Practice Address - Country:US
Practice Address - Phone:320-239-2246
Practice Address - Fax:320-239-2296
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN700466-9183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician