Provider Demographics
NPI:1881977718
Name:BALAKRISHNAN, SAMANTHA NICOLE (RN, DNP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:BALAKRISHNAN
Suffix:
Gender:F
Credentials:RN, DNP
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:NICOLE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.380019-COA1163W00000X
WARN00160851163W00000X
MNCNP3551363L00000X
WAAP60282025363LA2100X
OHCOA.13314-NP363LA2100X
CA95013703363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care