Provider Demographics
NPI:1740024355
Name:HALLOWELL, SAMANTHA (FNP-CC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HALLOWELL
Suffix:
Gender:F
Credentials:FNP-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 TROTTER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5968
Mailing Address - Country:US
Mailing Address - Phone:703-489-3492
Mailing Address - Fax:
Practice Address - Street 1:144 TROTTER RIDGE DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5968
Practice Address - Country:US
Practice Address - Phone:703-489-3492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHALL-7QXT8207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine