Provider Demographics
NPI:1952117467
Name:MORGAN, SAMANTHA (PMHNP)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W251S4432 OAK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7825
Mailing Address - Country:US
Mailing Address - Phone:708-288-4650
Mailing Address - Fax:
Practice Address - Street 1:W251S4432 OAK VIEW DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7825
Practice Address - Country:US
Practice Address - Phone:708-288-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029671363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.029671OtherPMHNP