Provider Demographics
NPI:1730889189
Name:TICHENOR, SAMANTHA A (APRN-CRNA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:TICHENOR
Suffix:
Gender:F
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:A
Other - Last Name:SORENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24607
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-0607
Mailing Address - Country:US
Mailing Address - Phone:402-955-5400
Mailing Address - Fax:402-955-3674
Practice Address - Street 1:8200 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-4370
Practice Address - Fax:402-955-4300
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101745367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered