Healthcare Provider Details

I. General information

NPI: 1821619859
Provider Name (Legal Business Name): SAMANTHA A SIMON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA ANN MAGYAR CRNA

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3000
  • Fax:
Mailing address:
  • Phone: 414-805-2715
  • Fax: 414-259-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number10153
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: