Provider Demographics
NPI:1265323497
Name:WHITLATCH, SAMANTHA (DNP, APNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WHITLATCH
Suffix:
Gender:F
Credentials:DNP, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6499 GINA LN
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-2419
Mailing Address - Country:US
Mailing Address - Phone:608-386-9018
Mailing Address - Fax:
Practice Address - Street 1:2985 TRIVERTON PIKE DR STE 201
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5803
Practice Address - Country:US
Practice Address - Phone:608-238-9991
Practice Address - Fax:888-608-0841
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17082-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health