Gudmunson, Samantha Nikole

Gudmunson, Samantha Nikole is an sole proprietor health care provider with primary practice located at 12 Health Services Dr , Dekalb IL 60115-9637. She recently has only one registered license in Nursing Service Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Gudmunson, Samantha Nikole can be contacted via phone (815) 756-4875.

Contact Information

Primary practice address
12 Health Services Dr Dekalb IL 60115-9637
Phone: (815) 756-4875
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Psychiatric/Mental Health 163WP0808X 041.411473 Illinois

Profile Details

NPI number 1619590981
LBN Legal business name Gudmunson, Samantha Nikole
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 21st, 2020
Last updated May 21st, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619590981 NPPES
Illinois MEDICAID 474579189001

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