MEDICARE: SAMANTHA ELIZABETH KANE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	R047483	SD
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1013805498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ELIZABETH KANE

Provider Business Mailing Address
First Line	:	3247 23RD AVENUE WEST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199
Country	:	US
Telephone Number	:	651-558-1036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2533 E MEADOWSIDE PL
Second Line	:	N/A
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-3706
Country	:	US
Telephone Number	:	651-558-1036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	06/25/2025

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Directions to “ SAMANTHA ELIZABETH KANE ” Practice Location

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