Provider Demographics
NPI:1871395665
Name:BUGNO, SAMANTHA (DNP, CPNP-PC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BUGNO
Suffix:
Gender:
Credentials:DNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 115TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-7117
Mailing Address - Country:US
Mailing Address - Phone:708-645-6129
Mailing Address - Fax:
Practice Address - Street 1:211 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3311
Practice Address - Country:US
Practice Address - Phone:312-229-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.031024363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics