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General NPI Number Information
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NPI Number | 1619775012
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Entity Type | Individual
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Provider Name | SAMANTHA MCGRAW
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Gender | Female
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 430 E DIVISION ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-4560
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Country | US
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Telephone | 920-926-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 548 GROVE ST
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City | OSHKOSH
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State | WI
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Zip | 54901-4608
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Country | US
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Telephone | 920-385-8007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 16491-33
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License Number State | WI
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