Healthcare Provider Details

I. General information

NPI: 1801750344
Provider Name (Legal Business Name): JOSEPHINE K SAMOLU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 WHITEHORSE HAMILTON SQUARE RD
HAMILTON NJ
08690-3535
US

IV. Provider business mailing address

28 HONEYSUCKLE DR
MARIETTA PA
17547-8500
US

V. Phone/Fax

Practice location:
  • Phone: 609-890-8200
  • Fax:
Mailing address:
  • Phone: 609-379-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15472200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: