Healthcare Provider Details

I. General information

NPI: 1932758968
Provider Name (Legal Business Name): SAMANTHA ROSE DOTSON DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA ROSE LANGNER

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WESTBROOK CORPORATE CTR STE 300
WESTCHESTER IL
60154-5709
US

IV. Provider business mailing address

1 WESTBROOK CORPORATE CTR STE 300
WESTCHESTER IL
60154-5709
US

V. Phone/Fax

Practice location:
  • Phone: 815-560-1726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018912
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: