Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 COOLIDGE HWY
ROYAL OAK MI
48073-1001
US

IV. Provider business mailing address

21319 REIMANVILLE AVE
FERNDALE MI
48220-2231
US

V. Phone/Fax

Practice location:
  • Phone: 248-288-9500
  • Fax:
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: