Healthcare Provider Details

I. General information

NPI: 1477207942
Provider Name (Legal Business Name): SAMARIA HALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27483 DEQUINDRE RD STE 306
MADISON HEIGHTS MI
48071-5715
US

IV. Provider business mailing address

21319 REIMANVILLE AVE
FERNDALE MI
48220-2231
US

V. Phone/Fax

Practice location:
  • Phone: 248-259-0461
  • Fax: 248-522-6077
Mailing address:
  • Phone: 248-346-1073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021208410
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: