Provider Demographics
NPI:1376853747
Name:ROBERTSON, SAMARA POTTIER (CNM, APRN)
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:POTTIER
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:SAMARA
Other - Middle Name:
Other - Last Name:POTTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, APRN
Mailing Address - Street 1:183 FOX POINT RD
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2720
Mailing Address - Country:US
Mailing Address - Phone:603-988-9880
Mailing Address - Fax:
Practice Address - Street 1:183 FOX POINT RD
Practice Address - Street 2:FOX POINT RD
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-0380
Practice Address - Country:US
Practice Address - Phone:603-988-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60450447163WL0100X
367A00000X
NH073486-23367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH073486-23OtherAPRN