1013778828 NPI number — SAMANTHA M WILLMAN CNM

Table of content: SAMANTHA M WILLMAN CNM (NPI 1013778828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013778828 NPI number — SAMANTHA M WILLMAN CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLMAN
Provider First Name:
SAMANTHA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRIEDENFELS
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013778828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
719 W HAMILTON AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAU CLAIRE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54701-6970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-552-9784
Provider Business Mailing Address Fax Number:
715-835-6370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3213 STEIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAU CLAIRE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54701-6946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-836-9242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)