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NPI Code Detail

MEDICARE: SAMANTHA BLAISDELL APRN

MEDICARE: SAMANTHA BLAISDELL APRN
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerCNP221183ME
2363LF0000XFamily Nurse Practitioner073969-23NH

General Provider Information

NPI Number : 1588052237
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA BLAISDELL APRN
Provider Business Mailing Address
First Line : 39 CLIPPER DR
Second Line :
City : WOLFEBORO
State : NH
Zip : 03894-4222
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 39 CLIPPER DR
Second Line :
City : WOLFEBORO
State : NH
Zip : 03894-4222
Country : US
Telephone Number : 603-569-3950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2015
Last Update Date : 06/03/2026

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