Provider Demographics
NPI:1508496621
Name:LAMERE, SAMANTHA JEAN MCGOUGH (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEAN MCGOUGH
Last Name:LAMERE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JEAN
Other - Last Name:MCGOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:
Practice Address - Street 1:347 SMITH AVE N STE 203
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2388
Practice Address - Country:US
Practice Address - Phone:651-241-7733
Practice Address - Fax:651-241-7798
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant