MEDICARE: SAMANTHA JO NIVEN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1447006762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JO NIVEN PA

Provider Business Mailing Address
First Line	:	506 GROTON RD
Second Line	:
City	:	WESTFORD
State	:	MA
Zip	:	01886-6326
Country	:	US
Telephone Number	:	978-399-0061
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 GROTON RD
Second Line	:
City	:	WESTFORD
State	:	MA
Zip	:	01886-6326
Country	:	US
Telephone Number	:	978-399-0061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	07/26/2024

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Directions to “ SAMANTHA JO NIVEN PA” Practice Location

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