Healthcare Provider Details

I. General information

NPI: 1053832113
Provider Name (Legal Business Name): SAMUEL ACHA ACHA FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MAIN ST
WESTBROOK ME
04092-3067
US

IV. Provider business mailing address

PO BOX 986523
BOSTON MA
02298-6523
US

V. Phone/Fax

Practice location:
  • Phone: 207-517-3800
  • Fax: 207-517-3819
Mailing address:
  • Phone: 603-410-6700
  • Fax: 603-319-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP171014
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: