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General NPI Number Information
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NPI Number | 1386250207
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Entity Type | Individual
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Provider Name | SAMANTHA ROSE PICHLER
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Gender | Female
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 101 FEDERAL ST
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City | BOSTON
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State | MA
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Zip | 02110-1817
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 3621 OAK RIDGE LN
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City | DOTHAN
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State | AL
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Zip | 36303-8303
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Country | US
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Telephone |
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1-157458
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN10016891
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License Number State | MA
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