Basic Information
| Provider Information | |||||||||
| NPI: | 1093777955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUGUELET | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7300 147TH ST W | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | APPLE VALLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551247541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529973020 | ||||||||
| FaxNumber: | 9529973026 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 SILVER LAKE RD NW | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551121786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516289566 | ||||||||
| FaxNumber: | 6516280411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 02/24/2017 | ||||||||
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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 | 364S00000X | R1345887 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 364SP0809X | CNS 0315 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 168946100 | 05 | MN | MEDICAID |