Dagenhardt, Samantha Gregory

Dagenhardt, Samantha Gregory is an individual health care provider with primary practice located at 121 W Main St , Port Washington WI 53074-1813. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Dagenhardt, Samantha Gregory can be contacted via phone (262) 284-8157.

Contact Information

Primary practice address
121 W Main St Port Washington WI 53074-1813
Phone: (262) 284-8157
Fax: (262) 284-8209
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 4747-33 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 4747-33 Wisconsin

Profile Details

NPI number 1659642841
LBN Legal business name Dagenhardt, Samantha Gregory
Credentials RN, MS, MSN, PMHCNS-
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 19th, 2012
Last updated Mar 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659642841 NPPES
Wisconsin Other 170792-30 RN
Wisconsin Other 4747-33 RN
Wisconsin MEDICAID 1659642841 RN
Wisconsin MEDICAID 100028338 RN

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