Healthcare Provider Details

I. General information

NPI: 1992246508
Provider Name (Legal Business Name): SAMANTHA LEE ORMOND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 08/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 FREMONT STREET
MARLBOROUGH MA
01752
US

IV. Provider business mailing address

101 GROVE STREET
SHREWSBURY MA
01545
US

V. Phone/Fax

Practice location:
  • Phone: 508-303-8553
  • Fax:
Mailing address:
  • Phone: 978-618-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2313666
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2313666
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: