Provider Demographics
NPI:1912292319
Name:KUSEK, SAMANTHA KAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:KAY
Last Name:KUSEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79166 467TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOUP CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68853-5141
Mailing Address - Country:US
Mailing Address - Phone:308-233-1178
Mailing Address - Fax:
Practice Address - Street 1:626 N ST
Practice Address - Street 2:
Practice Address - City:LOUP CITY
Practice Address - State:NE
Practice Address - Zip Code:68853-8110
Practice Address - Country:US
Practice Address - Phone:308-745-0780
Practice Address - Fax:308-745-0446
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE56301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse