Provider Demographics
NPI:1780280123
Name:SHYMANSKI, SAMANTHA (PMHNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SHYMANSKI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1306
Mailing Address - Country:US
Mailing Address - Phone:218-349-3076
Mailing Address - Fax:
Practice Address - Street 1:1150 MISSION RD
Practice Address - Street 2:
Practice Address - City:SAWYER
Practice Address - State:MN
Practice Address - Zip Code:55780
Practice Address - Country:US
Practice Address - Phone:218-879-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7935363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty