Healthcare Provider Details

I. General information

NPI: 1750667069
Provider Name (Legal Business Name): SAMANTHA ANN DAMREN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 12/18/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRINITY HEALTH IHA MEDICAL GROUP GYNECOLOGY ONCOLOGY 5303 ELLIOTT DRIVE SUITE 220
YPSILANTI MI
48197-8632
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE SUITE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-2005
  • Fax: 734-712-2013
Mailing address:
  • Phone: 734-647-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704256152
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5005406
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704256152
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: