Healthcare Provider Details

I. General information

NPI: 1588052237
Provider Name (Legal Business Name): SAMANTHA BLAISDELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CLIPPER DR
WOLFEBORO NH
03894-4222
US

IV. Provider business mailing address

39 CLIPPER DR
WOLFEBORO NH
03894-4222
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-3950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP221183
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number073969-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: