Healthcare Provider Details

I. General information

NPI: 1578345708
Provider Name (Legal Business Name): SAMANTHA WARREN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEMBERS WAY STE 203
DOVER NH
03820-5933
US

IV. Provider business mailing address

86 LINWOOD DR
ALTON NH
03809-5231
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-3174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number075762-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number075762-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: