Healthcare Provider Details

I. General information

NPI: 1134551880
Provider Name (Legal Business Name): SAMANTHA MARIE CUNNINGHAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 SERGEANT RD # 123
SIOUX CITY IA
51106-4708
US

IV. Provider business mailing address

5006 SERGEANT RD # 123
SIOUX CITY IA
51106-4708
US

V. Phone/Fax

Practice location:
  • Phone: 402-799-8042
  • Fax: 402-702-1269
Mailing address:
  • Phone: 402-799-8042
  • Fax: 402-702-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111559
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number111559
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberH177489
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP003105
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: