Basic Information
| Provider Information | |||||||||
| NPI: | 1609117555 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIKRU | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 888 W BONNEVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891060100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024836011 | ||||||||
| FaxNumber: | 7024836028 | ||||||||
| Practice Location | |||||||||
| Address1: | 4350 SHAWNEE MISSION PKWY STE 1200 | ||||||||
| Address2: | |||||||||
| City: | FAIRWAY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662052528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135880555 | ||||||||
| FaxNumber: | 9139455035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | TAPN700890 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 53-78303-102 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.