Samantha Radke
Individual provider Active NPI Registered Nurse · Jackson, WI
NPI 1124459243 · NPPES record last updated Feb 20, 2014
Key facts
- NPI
- 1124459243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 191522-30 (WI)
- Practice address
- W206N16731 Blackberry Cir
Unit 1525
Jackson, WI 53037-8963 - Phone
- (262) 573-9328
- NPI assigned
- Dec 1, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 191522-30 | WI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 191522-30 | WI | Yes |
Addresses
Primary practice location
W206N16731 Blackberry Cir
Unit 1525
Jackson, WI 53037-8963
Mailing address
W206N16731 Blackberry Cir
Unit 1525
Jackson, WI 53037-8963
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1122459243 | Medicaid | WI |
Other providers in Jackson, WI
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- Sonali Patel
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- Pharmscript of Wi LLC
- Pharmscript of Wi LLC
- Carol Lynn Radovich
- Sue C Radtke
- Christina Marie Rutsch
- Jessica Schaetzel
- Meghan Marie Schmitz
All providers in Jackson, WI · Registered Nurse in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.