NPI Code Detail JSON Logo

1558176438 NPI number — SAMANTHA MARIE BEAUDOIN

NPI Number: 1558176438
Health Care Provider/Practitioner: SAMANTHA MARIE BEAUDOIN

Information about “1558176438” NPI (SAMANTHA MARIE BEAUDOIN) exists in 1558176438 in HTML format HTML  |  1558176438 in plain Text format TXT  |  1558176438 in PDF (Portable Document Format) PDF  |  1558176438 in an XML format XML  formats.

NPI Number : 1558176438 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558176438",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BEAUDOIN",
    "FirstName": "SAMANTHA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CARABALLO",
    "OtherFirstName": "SAMANTHA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1203 BROUGHTON DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEVERLY",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01915-1851",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-671-4471",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "77 HERRICK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEVERLY",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "01915-2734",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "978-927-4110",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/10/2025",
    "LastUpdateDate": "04/09/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "RN2390912",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "RN2390912",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.