Healthcare Provider Details

I. General information

NPI: 1861755209
Provider Name (Legal Business Name): SAMANTHA HELENE MITCHELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 RIDGEWOOD DR
BANGOR ME
04401-2652
US

IV. Provider business mailing address

381 MAIN ST
ORONO ME
04473-3446
US

V. Phone/Fax

Practice location:
  • Phone: 207-942-0669
  • Fax: 207-947-3143
Mailing address:
  • Phone: 207-942-0689
  • Fax: 207-947-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberCNP121048
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: