Healthcare Provider Details

I. General information

NPI: 1457927766
Provider Name (Legal Business Name): SAMANTHA MARIE BREKKEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA MARIE BRYCE

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 7TH AVE S
SAINT CLOUD MN
56301-5711
US

IV. Provider business mailing address

122 COLFAX AVE SW STE 3
WADENA MN
56482-1471
US

V. Phone/Fax

Practice location:
  • Phone: 320-760-3474
  • Fax:
Mailing address:
  • Phone: 320-815-8072
  • Fax: 320-201-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7468
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: