Healthcare Provider Details

I. General information

NPI: 1467364232
Provider Name (Legal Business Name): KAYLEE SAMPEL BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLEE HAUG

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 24TH AVE S STE 100
GRAND FORKS ND
58201-6761
US

IV. Provider business mailing address

824 N 39TH ST
GRAND FORKS ND
58203-2015
US

V. Phone/Fax

Practice location:
  • Phone: 701-335-4380
  • Fax:
Mailing address:
  • Phone: 218-280-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR54434
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: