Individual
SAMANTHA GREGORY DAGENHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MS, MSN, PMHCNS-
Contact information
Practice address
121 W MAIN ST, PORT WASHINGTON, WI 53074-1813
(262) 284-8157
(262) 284-8209
Mailing address
121 W MAIN ST, PORT WASHINGTON, WI 53074-1813
(262) 284-8200
(262) 284-8103
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4747-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4747-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100028338
—
WI
05
—
1659642841
—
WI
01
—
170792-30
RN
WI
01
—
4747-33
APNP
WI
Enumeration date
01/19/2012
Last updated
03/07/2023
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