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General NPI Number Information
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NPI Number | 1720845175
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Entity Type | Individual
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Provider Name | SAMANTHA EMILY MAGRUDER FNP
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Gender | Female
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 5741 W CERMAK RD
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City | CICERO
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State | IL
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Zip | 60804-2129
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Country | US
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Telephone | 708-222-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone | 847-390-5900
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 209-029764
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.029764
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041470079
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License Number State | IL
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