Healthcare Provider Details

I. General information

NPI: 1356294086
Provider Name (Legal Business Name): SAMANTHA KAY MARION MSN, RN, ACPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA KAY SCOGGIN NP

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MICHIGAN ST NE STE 4200
GRAND RAPIDS MI
49503-2559
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-9150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704330669
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: