Provider Demographics
NPI:1184362402
Name:ROZEBOOM, SAMANTHA LEIGH (DNP)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:ROZEBOOM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 230TH ST
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51240-7570
Mailing Address - Country:US
Mailing Address - Phone:605-366-2402
Mailing Address - Fax:
Practice Address - Street 1:1301 S CLIFF AVE STE 610
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA160183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily