MEDICARE: SAMANTHA LYNN KAPUSCINSKI CRNP

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	363LA2200X	Adult Health Nurse Practitioner	307617	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821459066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LYNN KAPUSCINSKI CRNP

Provider Business Mailing Address
First Line	:	4936 MAIN ST
Second Line	:
City	:	BEMUS POINT
State	:	NY
Zip	:	14712-9667
Country	:	US
Telephone Number	:	716-386-2414
Fax Number	:	716-386-2437

Provider Business Practice Location Address
First Line	:	4936 MAIN ST
Second Line	:
City	:	BEMUS POINT
State	:	NY
Zip	:	14712-9667
Country	:	US
Telephone Number	:	716-386-2414
Fax Number	:	716-386-2437

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

Provider Enumeration Date	:	03/16/2016
Last Update Date	:	05/21/2026

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