Healthcare Provider Details

I. General information

NPI: 1760236608
Provider Name (Legal Business Name): SAMANTHA FALKOWSKI RN, BSN, CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 W CONNELL AVE
MILWAUKEE WI
53226-3067
US

IV. Provider business mailing address

3570 S 82ND ST
MILWAUKEE WI
53220-1024
US

V. Phone/Fax

Practice location:
  • Phone: 414-534-6798
  • Fax:
Mailing address:
  • Phone: 414-534-6798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number196293-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: