Healthcare Provider Details

I. General information

NPI: 1376853747
Provider Name (Legal Business Name): SAMARA IDA POTTIER-TACCETTA CNM, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMARA POTTIER CNM, APRN

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FABYAN PT
NEWINGTON NH
03801-2756
US

IV. Provider business mailing address

3 FABYAN PT
NEWINGTON NH
03801-2756
US

V. Phone/Fax

Practice location:
  • Phone: 603-988-9880
  • Fax:
Mailing address:
  • Phone: 603-988-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN60450447
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number073486-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: