Healthcare Provider Details

I. General information

NPI: 1255815965
Provider Name (Legal Business Name): REBECCA LEIGH SAMBERG DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E 3RD ST
CASPER WY
82601-2905
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 307-266-2772
  • Fax: 307-266-2076
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1801
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: