Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Samantha Rose Khundmiri, RN, APNP

Individual provider Family Nurse Practitioner · NPI 1104402361

Samantha Rose Khundmiri, RN, APNP is a Nurse Practitioner in Greendale, Wisconsin. Qualified in 2016, 10 years ago. Practices with Froedtert Andthe Medical College of Wisconsin Community Physicians Inc, a 1,255-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Wisconsin.

Years since qualifying
10
Licensed in
WI
In the registry since
2021
Specialties on file
2
What do these letters mean?
RN — Registered Nurse
A licensed nurse who completed a nursing degree and passed the NCLEX-RN examination.

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Practice location Address checks out

6220 W Loomis Rd
Greendale, WI 53129-2448
Phone: (414) 423-0555
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 11302-33 (WI)
Registered Nurse Taxonomy 163W00000X · Licence 230241-30 (WI)

Record details

NPI number1104402361
Entity typeIndividual (Type 1)
GenderFemale
Credentials RN , APNP
Sole proprietorNo
NPI enumeratedMarch 19, 2021
Last updated in NPPESSeptember 27, 2021
Certification dateSeptember 27, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Froedtert Andthe Medical College Of Wisconsin Community Physicians Inc — 1255 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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