MEDICARE: SAMANTHA MUNSON

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1457747214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MUNSON

Provider Business Mailing Address
First Line	:	262 AVENUE RD
Second Line	:
City	:	LEVANT
State	:	ME
Zip	:	04456-4010
Country	:	US
Telephone Number	:	207-404-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 AVENUE RD
Second Line	:
City	:	LEVANT
State	:	ME
Zip	:	04456-4003
Country	:	US
Telephone Number	:	207-848-4928
Fax Number	:

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

Provider Enumeration Date	:	04/08/2015
Last Update Date	:	11/09/2019

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