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General NPI Number Information
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NPI Number | 1508587726
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Entity Type | Individual
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Provider Name | SAMANTHA LAUREN HENNIS MSN, APRN, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-444-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 SAINT ANDREWS CIR
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City | BRUNSWICK
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State | OH
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Zip | 44212-3284
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Country | US
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Telephone | 440-503-5543
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN.CNP.0032276
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License Number State | OH
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