1023802634 NPI number — SAMANTHA MARIE PLANT ROSE CRNP

Table of content: SAMANTHA MARIE PLANT ROSE CRNP (NPI 1023802634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023802634 NPI number — SAMANTHA MARIE PLANT ROSE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSE
Provider First Name:
SAMANTHA
Provider Middle Name:
MARIE PLANT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PLANT
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023802634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 MAYO RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWATER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21037-2951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-956-6302
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 MAYO RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWATER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21037-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-956-6302
Provider Business Practice Location Address Fax Number:
410-956-6637
Provider Enumeration Date:
04/08/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R234139 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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