Provider Demographics
NPI:1700693611
Name:WARREN, SAMANTHA (DNP)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2230
Mailing Address - Country:US
Mailing Address - Phone:248-924-1931
Mailing Address - Fax:
Practice Address - Street 1:503 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2230
Practice Address - Country:US
Practice Address - Phone:248-924-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704359038363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology