Healthcare Provider Details

I. General information

NPI: 1912719378
Provider Name (Legal Business Name): SAMANTHA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ENTERPRISE DR STE 100
AUGUSTA ME
04330-7998
US

IV. Provider business mailing address

47 HILL ROAD
CLINTON ME
04927
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP251023
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: