MEDICARE: SAMANTHA ARLENE MALLEY MSN, ARNP, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A163457	IA

General Provider Information

NPI Number	:	1326622655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ARLENE MALLEY MSN, ARNP, FNP-C

Provider Business Mailing Address
First Line	:	15 OAK ST STE 3
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02492-2470
Country	:	US
Telephone Number	:	888-671-5902
Fax Number	:	339-686-3137

Provider Business Practice Location Address
First Line	:	15 OAK ST STE 3
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02492-2470
Country	:	US
Telephone Number	:	888-671-5902
Fax Number	:	339-686-3137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	05/08/2026

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