Healthcare Provider Details

I. General information

NPI: 1447952098
Provider Name (Legal Business Name): SAMANTHA SKOGEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2663 SALT CREEK HWY
CASPER WY
82601-9659
US

IV. Provider business mailing address

PO BOX 1503
CASPER WY
82602-1503
US

V. Phone/Fax

Practice location:
  • Phone: 716-291-1423
  • Fax:
Mailing address:
  • Phone: 716-291-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number44010
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: