Samantha Shymanski, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

7935 Issued in MN

Practice address

1150 Mission Rd
Sawyer, MN 55780

Phone

(218) 879-6731

NPI assigned

Dec 10, 2020

Last updated

Dec 10, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Minnesota Indian Primary Residential Treatment Center, Inc.

  dba Mash-ka-wisen Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Sawyer, MN
  • NPI 1578621579

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1780280123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "738 BIRCH ST",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201306",
            "telephone_number": "218-349-3076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 MISSION RD",
            "city": "SAWYER",
            "state": "MN",
            "postal_code": "55780",
            "telephone_number": "218-879-6731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHYMANSKI",
        "first_name": "SAMANTHA",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-10",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "7935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Allan Holmes, LADC
• Ramona Marie Hunter, PSYD LP LADC
• Minnesota Indian Primary Residential Treatment Center, Inc. (Mash-ka-wisen Treatment Center)

• Psychiatric/Mental Health Nurse Practitioner in Sawyer, MN
• Providers in Sawyer, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.