Provider Demographics
NPI:1740919810
Name:FRUEHAUF, SAMANTHA ELIZABETH (PA)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:FRUEHAUF
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:7400 W STATE ST APT 341
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2775
Mailing Address - Country:US
Mailing Address - Phone:716-857-1225
Mailing Address - Fax:
Practice Address - Street 1:10625 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2315
Practice Address - Country:US
Practice Address - Phone:414-877-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-03-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant