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General NPI Number Information
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NPI Number | 1801528203
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Entity Type | Individual
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Provider Name | SAMANTHA CHAN RN
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Gender | Female
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Dates
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Enumeration Date | 06/26/2022
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Last Update Date | 06/26/2022
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Provider Practice Location Address
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Address Line | 12 QUEEN ST
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City | WORCESTER
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State | MA
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Zip | 01610-2411
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Country | US
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Telephone | 508-860-1239
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CARRUTH DR
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City | NORTHBOROUGH
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State | MA
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Zip | 01532-1400
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Country | US
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Telephone | 508-439-7460
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN2334245
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License Number State | MA
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