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General NPI Number Information
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NPI Number | 1417430554
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Entity Type | Individual
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Provider Name | SAMANTHA RENY PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 10 HIGH ST STE 301
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City | LEWISTON
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State | ME
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Zip | 04240-7656
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Country | US
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Telephone | 207-795-8385
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Fax | 207-795-5649
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Provider Business Mailing Address
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Address Line | 3 CHELSEA WAY APT 303
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City | CUMBERLAND FORESIDE
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State | ME
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Zip | 04110-1363
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Country | US
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Telephone | 207-807-7441
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP181123
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License Number State | ME
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