Healthcare Provider Details

I. General information

NPI: 1750168399
Provider Name (Legal Business Name): SAMANTHA GALL MSN, AGCNS-BC, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

18930 W PINECREST LN
NEW BERLIN WI
53146-1429
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-8109
  • Fax:
Mailing address:
  • Phone: 262-993-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number17627-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: