Healthcare Provider Details

I. General information

NPI: 1700734969
Provider Name (Legal Business Name): SAMANTHA HUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 S 34TH ST APT 16
GRAND FORKS ND
58201-8806
US

IV. Provider business mailing address

1115 10TH ST
MANVEL ND
58256-4330
US

V. Phone/Fax

Practice location:
  • Phone: 218-779-2660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHUT865699
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: