MEDICARE: SAMANTHA BERGLUND RN

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	163WG0100X	Gastroenterology Registered Nurse	R-218980-6	MN

General Provider Information

NPI Number	:	1629901053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BERGLUND RN

Provider Business Mailing Address
First Line	:	3001 BROADWAY ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2195
Country	:	US
Telephone Number	:	612-871-1145
Fax Number	:	612-870-5812

Provider Business Practice Location Address
First Line	:	3001 BROADWAY ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2195
Country	:	US
Telephone Number	:	612-871-1145
Fax Number	:	612-870-5812

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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