Provider Demographics
NPI:1699255216
Name:ROGERS, SAMANTHA ANN (DNP, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9506 GUNVIEW RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1409
Mailing Address - Country:US
Mailing Address - Phone:410-207-0038
Mailing Address - Fax:
Practice Address - Street 1:222 BOSLEY AVENUE
Practice Address - Street 2:SUITE C3
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-988-2503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191686363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health