Provider Demographics
NPI:1861755209
Name:MITCHELL, SAMANTHA HELENE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:HELENE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3446
Mailing Address - Country:US
Mailing Address - Phone:207-942-0689
Mailing Address - Fax:207-947-3143
Practice Address - Street 1:90 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2652
Practice Address - Country:US
Practice Address - Phone:207-942-0669
Practice Address - Fax:207-947-3143
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP121048207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1952536880OtherNPI
ME1952536880OtherNPI