Provider Demographics
NPI:1457747214
Name:MUNSON, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MUNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:LEVANT
Mailing Address - State:ME
Mailing Address - Zip Code:04456-4010
Mailing Address - Country:US
Mailing Address - Phone:207-404-0909
Mailing Address - Fax:
Practice Address - Street 1:245 AVENUE RD
Practice Address - Street 2:
Practice Address - City:LEVANT
Practice Address - State:ME
Practice Address - Zip Code:04456-4003
Practice Address - Country:US
Practice Address - Phone:207-848-4928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program