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General NPI Number Information
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NPI Number | 1215595640
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Entity Type | Individual
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Provider Name | SAMANTHA ANN JOHNSEN
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Gender | Female
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 400 RENAISSANCE CTR
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City | DETROIT
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State | MI
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Zip | 48243-1502
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 8906 SPANISH RIDGE AVE STE 202
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City | LAS VEGAS
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State | NV
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Zip | 89148-1319
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Country | US
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Telephone | 702-330-3102
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Fax | 702-912-4994
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | RN71057
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 386709
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License Number State | NV
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