Provider Demographics
NPI:1740791110
Name:HARRIS, SAMANTHA MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BRIDGE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-8925
Mailing Address - Country:US
Mailing Address - Phone:413-213-0550
Mailing Address - Fax:
Practice Address - Street 1:35 BRIDGE ST STE 1
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-8925
Practice Address - Country:US
Practice Address - Phone:413-213-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2284019363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily