Individual provider · Type 1 NPI
Samantha Marie Gudgeon, NURSE PRACTITIONER
Nurse Practitioner · Coon Rapids, MN
Practice location
4040 Coon Rapids Blvd NW Ste 120
Coon Rapids, MN 55433-4568
Fax (763) 236-8903
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner Primary | 363L00000X | 14503 (MN) |
| Family Nurse Practitioner | 363LF0000X | 2514023 (MN) |
Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…
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About NPI 1174443261
Samantha Marie Gudgeon, NURSE PRACTITIONER's National Provider Identifier is 1174443261, issued on Jul 17, 2026. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Coon Rapids, MN. The record was last updated on Aug 12, 2026.