SAMANTHA GREGORY DAGENHARDT (NPI# 1659642841) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659642841 |
| Entity Type | Individual |
| Full Name | SAMANTHA GREGORY DAGENHARDT |
| Credential | RN, MS, MSN, PMHCNS- |
| Practice Address |
1220 Dewey Ave Wauwatosa WI 53213-2504 |
| Practice Telephone | 4144546566 |
| Practice Fax Number | 4144546522 |
| Mailing Telephone | 4144546566 |
| Mailing Fax Number | 4144546522 |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2020-03-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 4747-33 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
4747-33 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | MG2558685 | 01 | |
| WI | 100028338 | 05 | |
| WI | APNP | 4747-33 | 01 |
| WI | 1659642841 | 05 | |
| WI | RN | 170792-30 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 121 W Main St, Port Washington, WI 530741813 | 2622848157 | 2622848209 |
| Street Address |
1220 DEWEY AVE |
| City | WAUWATOSA |
| State | WI |
| Zip Code | 53213-2504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083696736 | Ikar Jaksa Kalogjera | Psychiatry & Neurology | 1220 Dewey Ave, Wauwatosa, WI 53213-2504 | 2005-11-17 |
| 1407464118 | Geoffrey B Watters | Nurse Practitioner | 1220 Dewey Ave, Wauwatosa, WI 53213-2504 | 2020-07-20 |
| 1497381818 | Frances Clouse | Pharmacist | 1220 Dewey Ave, Wauwatosa, WI 53213-2504 | 2020-03-17 |
| 1851939623 | Kathleen Grace Barnes | Physician Assistant | 1220 Dewey Ave, Wauwatosa, WI 53213-2504 | 2019-12-12 |
| 1952951402 | Christine D Schubring | Nurse Practitioner | 1220 Dewey Ave, Wauwatosa, WI 53213-2504 | 2019-09-17 |
| 1043864242 | Brooke E Muggenthaler | Counselor | 1220 Dewey Ave, Wauwatosa, WI 53213-2504 | 2019-07-26 |
| 1225510001 | Reuel Kagamba Muiruri | Nurse Practitioner | 1220 Dewey Ave, Wauwatosa, WI 53213-2504 | 2018-08-29 |
| 1437638830 | Lori L Unger | Registered Nurse | 1220 Dewey Ave, Wauwatosa, WI 53213-2504 | 2018-08-07 |
| 1033697644 | Christine S Schultz | Social Worker | 1220 Dewey Ave, Wauwatosa, WI 53213-2504 | 2018-08-06 |
| 1205335957 | Ivana Spaciel | Nurse Practitioner | 1220 Dewey Ave, Wauwatosa, WI 53213-2504 | 2018-02-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932682473 | Tracy A Bolton | Nurse Practitioner | 2626 N 76th St Ste 101, Wauwatosa, WI 53213 | 2018-09-11 |
| 1609309129 | Anupriya Dayal | Student in an Organized Health Care Education/Training Program | 7700 Portland Avenue, #227, Milwaukee, WI 53213 | 2017-04-11 |
| 1407202666 | Michael Lenz | Dentist | 1221 N 62nd Street, 201, Wauwatosa, WI 53213 | 2016-05-06 |
| 1164807889 | Myia Mitchell | Massage Therapist | 6012 W. North Avenue, Milwaukee, WI 53213 | 2015-07-23 |
| 1518369420 | Rachel Rakow | Speech-Language Pathologist | 1009 N 92nd St, Wauwatosa, WI 53213 | 2014-09-23 |
| 1821348335 | Mary Kathryn Maxey | Dietitian, Registered | 1515 Mower Court, Wauwatosa, WI 53213 | 2012-09-12 |
| 1134478506 | Andrea Brooke Moosreiner | Dietitian, Registered | 7220 Milwaukee Ave, Wauwatosa, WI 53213 | 2012-08-31 |
| 1467726075 | Stephanie Miller | Social Worker | 2618 N 61st St, Milwaukee, WI 53213 | 2012-02-28 |
| 1396013447 | Ng Enterprise, Inc. | Home Health | 7635 West Bluemound Road, Suite 1b, Milwaukee, WI 53213 | 2011-12-05 |
| 1184908162 | Lisa Anne Behlmer | Pharmacist | 6600 W. State St, Wauwatosa, WI 53213 | 2011-10-07 |
| Find all providers in zip 53213 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003422726 | Wisconsin Healthcare Family Practices and Behavioral Services LLC | Nurse Practitioner | 10721 W Capitol Dr Ste G103, Wauwatosa, WI 53222-1210 | 2020-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689292856 | Julianne Margaret John | Nurse Practitioner | 3237 S 16th St Ste 310, Milwaukee, WI 53215-4526 | 2020-07-13 |
| 1356968002 | Marisa Hiley | Nurse Practitioner | W129 N7055 Northfield Drive, Menomonee Falls, WI 53051 | 2020-06-29 |
| 1932726700 | Lauren Marie Skemp | Nurse Practitioner | 1960 Hyview Rd, Cuba City, WI 53807-9718 | 2020-06-28 |
| 1235779240 | Conscious Practice, LLC | Nurse Practitioner | 119 19th St N, La Crosse, WI 54601-3724 | 2020-01-08 |
| 1073152161 | Stephanie L Ruskell | Nurse Practitioner | 3805 Spring St Ste 240, Mount Pleasant, WI 53405-1667 | 2020-01-06 |
| 1558924811 | Sarah Kathryn Garven | Nurse Practitioner | 5000 West National Ave Rm 3119, Milwaukee, WI 53295-1000 | 2019-04-22 |
| 1104394535 | Therese Ann Alm | Nurse Practitioner | 383 Williamstowne Ste 101, Delafield, WI 53018-2332 | 2018-11-03 |
| 1477079242 | Aeron Rachel Adams | Nurse Practitioner | W10237 Lake Emily Rd, Fox Lake, WI 53933 | 2017-08-14 |
| 1396140398 | Monica Gorski | Nurse Practitioner | 505 King St Ste 218, La Crosse, WI 54601-4289 | 2014-11-03 |
| 1518217280 | Jodi L Space | Nurse Practitioner | 5416 Everybodys Rd, Crandon, WI 54520-8627 | 2012-09-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.