Provider Demographics
NPI:1659102085
Name:FAMANAS, SAMIEBERT (RN)
Entity type:Individual
Prefix:
First Name:SAMIEBERT
Middle Name:
Last Name:FAMANAS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8518 GEORGIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2908
Mailing Address - Country:US
Mailing Address - Phone:847-744-3237
Mailing Address - Fax:773-904-0393
Practice Address - Street 1:8518 GEORGIANA AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2908
Practice Address - Country:US
Practice Address - Phone:847-744-3237
Practice Address - Fax:773-904-0393
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041322676163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult