Healthcare Provider Details

I. General information

NPI: 1326622655
Provider Name (Legal Business Name): SAMANTHA ARLENE MALLEY MSN, ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OAK ST STE 3
NEEDHAM MA
02492-2470
US

IV. Provider business mailing address

15 OAK ST STE 3
NEEDHAM MA
02492-2470
US

V. Phone/Fax

Practice location:
  • Phone: 888-671-5902
  • Fax: 339-686-3137
Mailing address:
  • Phone: 888-671-5902
  • Fax: 339-686-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA163457
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: