MEDICARE: SAMANTHA BEAUDOIN NP

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	363LF0000X	Family Nurse Practitioner	RN2309104	MA

General Provider Information

NPI Number	:	1720648561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BEAUDOIN NP

Provider Business Mailing Address
First Line	:	42 BRIERE DR
Second Line	:
City	:	CHICOPEE
State	:	MA
Zip	:	01020-1138
Country	:	US
Telephone Number	:	413-530-1254
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 N MAIN ST
Second Line	:	STE 101
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-1834
Country	:	US
Telephone Number	:	413-525-1870
Fax Number	:

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

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	04/09/2025

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