Provider Demographics
NPI:1417727975
Name:ROBERTS, SAMANTHA (CNA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 MOUNT HOPE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4098
Mailing Address - Country:US
Mailing Address - Phone:207-573-1794
Mailing Address - Fax:
Practice Address - Street 1:68 MOUNT HOPE AVE STE 2
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4098
Practice Address - Country:US
Practice Address - Phone:207-573-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNA60132376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide