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NPI Code Detail

MEDICARE: SAMANTHA ELIZABETH DUMAIS LAT, ATC

MEDICARE: SAMANTHA ELIZABETH DUMAIS LAT, ATC
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
12255A2300XAthletic Trainer1200-25ND

General Provider Information

NPI Number : 1649163957
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ELIZABETH DUMAIS LAT, ATC
Provider Business Mailing Address
First Line : 1727 42ND ST S APT 4
Second Line :
City : FARGO
State : ND
Zip : 58103-4455
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1600 UNIVERSITY DR N
Second Line :
City : FARGO
State : ND
Zip : 58105-2502
Country : US
Telephone Number : 701-231-6378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2025
Last Update Date : 06/03/2025

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