Healthcare Provider Details

I. General information

NPI: 1477255628
Provider Name (Legal Business Name): SAMANTHA MAHER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 PROSPECT ST
LEE MA
01238-1128
US

IV. Provider business mailing address

312 PROSPECT ST
LEE MA
01238-1128
US

V. Phone/Fax

Practice location:
  • Phone: 413-822-8838
  • Fax:
Mailing address:
  • Phone: 413-464-1586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2310978
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: