Provider Demographics
NPI:1447952098
Name:SKOGEN, SAMANTHA (RN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SKOGEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1503
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82602-1503
Mailing Address - Country:US
Mailing Address - Phone:716-291-1423
Mailing Address - Fax:
Practice Address - Street 1:2663 SALT CREEK HWY
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-9659
Practice Address - Country:US
Practice Address - Phone:716-291-1423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY44010163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health