Healthcare Provider Details

I. General information

NPI: 1407259641
Provider Name (Legal Business Name): SAMANTHA HENRY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 TRAPPE ST
FULTON MD
20759-2614
US

IV. Provider business mailing address

7321 TRAPPE ST
FULTON MD
20759-2614
US

V. Phone/Fax

Practice location:
  • Phone: 301-233-3430
  • Fax:
Mailing address:
  • Phone: 301-233-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR193882
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015924
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: