Healthcare Provider Details

I. General information

NPI: 1649163957
Provider Name (Legal Business Name): SAMANTHA ELIZABETH DUMAIS LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 UNIVERSITY DR N
FARGO ND
58105-2502
US

IV. Provider business mailing address

1727 42ND ST S APT 4
FARGO ND
58103-4455
US

V. Phone/Fax

Practice location:
  • Phone: 701-231-6378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1200-25
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: