Healthcare Provider Details

I. General information

NPI: 1023802634
Provider Name (Legal Business Name): SAMANTHA MARIE PLANT ROSE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA MARIE PLANT

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 MAYO RD STE A
EDGEWATER MD
21037-2951
US

IV. Provider business mailing address

224 MAYO RD STE A
EDGEWATER MD
21037-2951
US

V. Phone/Fax

Practice location:
  • Phone: 410-956-6302
  • Fax: 410-956-6637
Mailing address:
  • Phone: 410-956-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR234139
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: