Provider Demographics
NPI:1962132035
Name:HASENZAHL, SAMANTHA (PMHNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HASENZAHL
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 1:1513 FORT HILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3736
Mailing Address - Country:US
Mailing Address - Phone:804-852-1445
Mailing Address - Fax:
Practice Address - Street 1:2301 N PARHAM RD STE 5
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-3171
Practice Address - Country:US
Practice Address - Phone:804-270-1124
Practice Address - Fax:804-270-2090
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001269939163W00000X
VA0024184707163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health