Provider Demographics
NPI:1609117555
Name:FIKRU, SAMANTHA ANNETTE (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANNETTE
Last Name:FIKRU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 W BONNEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-0100
Mailing Address - Country:US
Mailing Address - Phone:702-483-6011
Mailing Address - Fax:702-483-6028
Practice Address - Street 1:4350 SHAWNEE MISSION PKWY STE 1200
Practice Address - Street 2:
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-2528
Practice Address - Country:US
Practice Address - Phone:913-588-0555
Practice Address - Fax:913-945-5035
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVTAPN700890363LF0000X
KS53-78303-102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily