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NPI 1083380653

IndividualActive

Samantha Illsley

NPI 1083380653 · Technician/Technologist · Saint Cloud, MN

Provider details

NPI number: 1083380653
Entity type: Individual
Primary specialty: Technician/TechnologistEye and Vision Services Providers
Sex: Female
Sole proprietor: Yes

Practice location

141 33rd Ave S

Saint Cloud, MN 56301-3753

Phone: (320) 443-6250

More MN providers

Mailing address

141 33rd Ave S

Saint Cloud, MN 56301-3753

Registry dates

Enumerated: 2021-08-23
Last updated: 2021-08-23

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Samantha Illsley — NPI 1083380653, Saint Cloud, MN | NPI Central