Healthcare Provider Details

I. General information

NPI: 1962132035
Provider Name (Legal Business Name): SAMANTHA HASENZAHL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N PARHAM RD STE 5
RICHMOND VA
23229-3171
US

IV. Provider business mailing address

1513 FORT HILL DR
RICHMOND VA
23226-3736
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-1124
  • Fax: 804-270-2090
Mailing address:
  • Phone: 804-852-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001269939
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0024184707
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024184707
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: