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General NPI Number Information
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NPI Number | 1821733288
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Entity Type | Individual
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Provider Name | SAMNANG SAN
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Gender | Male
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Dates
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Enumeration Date | 04/30/2022
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Last Update Date | 04/30/2022
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Provider Practice Location Address
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Address Line | 35 E DUNSTABLE RD
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City | NASHUA
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State | NH
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Zip | 03060-5863
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Country | US
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Telephone | 978-994-6030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 700
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City | DRACUT
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State | MA
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Zip | 01826-0700
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Country | US
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Telephone |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LN66580
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License Number State | MA
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