Active NPI
Samantha Whitacre, RN
- Registered Nurse
- Wyoming, MN
National Provider Identifier
1255731618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 214538-7
- Practice address
- 5200 Fairview Blvd
Wyoming, MN 55092-8013 - Phone
- (651) 982-7000
- NPI assigned
- Sep 3, 2014
- Last updated
- Sep 3, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 214538-7 | MN | Primary |
Addresses
Primary practice location
5200 Fairview Blvd
Wyoming, MN 55092-8013
Mailing address
504 Moline Loop NW
Isanti, MN 55040-6515
Phone (320) 249-7938
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 214538-7 | MN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409702400000",
"number": "1255731618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 MOLINE LOOP NW",
"city": "ISANTI",
"state": "MN",
"postal_code": "550406515",
"telephone_number": "320-249-7938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5200 FAIRVIEW BLVD",
"city": "WYOMING",
"state": "MN",
"postal_code": "550928013",
"telephone_number": "651-982-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITACRE",
"first_name": "SAMANTHA",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-03",
"last_updated": "2014-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "214538-7",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyoming, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.