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NPI Code Detail

MEDICARE: MS. SAMANTHA DANNETTE MCCLUSKEY ACNP

MEDICARE: MS. SAMANTHA DANNETTE MCCLUSKEY ACNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner96665CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1500003975OTHERCORAILROAD

General Provider Information

NPI Number : 1053366179
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SAMANTHA DANNETTE MCCLUSKEY ACNP
Provider Business Mailing Address
First Line : 1372 17 RD
Second Line :
City : FRUITA
State : CO
Zip : 81521-9214
Country : US
Telephone Number : 970-314-3080
Fax Number : 970-257-2401
Provider Business Practice Location Address
First Line : 2754 COMPASS DR STE 377
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-8723
Country : US
Telephone Number : 970-314-3080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 04/22/2021

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