Healthcare Provider Details

I. General information

NPI: 1659914182
Provider Name (Legal Business Name): SAMANTHA DAWN PRICE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41000 WOODWARD AVE
BLOOMFIELD HILLS MI
48304-5130
US

IV. Provider business mailing address

339 N CEDAR LAKE RD
STANTON MI
48888-9489
US

V. Phone/Fax

Practice location:
  • Phone: 313-217-9213
  • Fax:
Mailing address:
  • Phone: 517-242-1348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704289105
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: