Samantha Dietman
Individual provider Active NPI Licensed Practical Nurse · Saint Cloud, MN
NPI 1497565899 · NPPES record last updated Jan 9, 2025
Key facts
- NPI
- 1497565899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- L72612-2 (MN)
- Practice address
- 4801 Veterans Dr
Saint Cloud, MN 56303-2015 - Phone
- (320) 252-1670
- NPI assigned
- Jan 9, 2025
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| L72612-2 | MN | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | L72612-2 | MN | Yes |
Addresses
Primary practice location
4801 Veterans Dr
Saint Cloud, MN 56303-2015
Mailing address
2517 Ocarina Dr
Sauk Rapids, MN 56379-4608
Other providers in Saint Cloud, MN
- Sara Dezell
- Gati Niranjan Dhroove
- Heather Diaz
- Kelsey A Diederich
- Leah Diederich
- Tabitha Paige Dietz
- Dima Transportation LLC
- Lindsay J Dingman
- Amanda Lee Dingmann
- Bethany T. Dingmann
All providers in Saint Cloud, MN · Licensed Practical Nurse in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2025. 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.