Provider Demographics
NPI:1104514850
Name:KOST, SAMANTHA JEAN
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEAN
Last Name:KOST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523-6715
Mailing Address - Country:US
Mailing Address - Phone:701-880-1493
Mailing Address - Fax:
Practice Address - Street 1:404 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523-6715
Practice Address - Country:US
Practice Address - Phone:701-880-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant