MEDICARE: SAMANTHA DOE NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP141119	ME
2	363LF0000X	Family Nurse Practitioner	CNP141119	ME

General Provider Information

NPI Number	:	1982093753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA DOE NP

Provider Business Mailing Address
First Line	:	50 CRESTMONT AVE
Second Line	:
City	:	MILLINOCKET
State	:	ME
Zip	:	04462-1906
Country	:	US
Telephone Number	:	207-504-0588
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 HARPSWELL RD
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-2549
Country	:	US
Telephone Number	:	207-295-2190
Fax Number	:

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

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	08/26/2024

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