Provider Demographics
NPI:1588929947
Name:MORRISON-MA, SAMANTHA (NP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MORRISON-MA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 GOVERNORS AVE
Mailing Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES INC.
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3017
Mailing Address - Country:US
Mailing Address - Phone:781-395-6122
Mailing Address - Fax:781-395-2595
Practice Address - Street 1:49 GOVERNORS AVE
Practice Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES INC.
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3017
Practice Address - Country:US
Practice Address - Phone:781-395-6122
Practice Address - Fax:781-395-2595
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2270014363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner