Provider Demographics
NPI:1447006762
Name:NIVEN, SAMANTHA JO (PA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:NIVEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:506 GROTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-6326
Mailing Address - Country:US
Mailing Address - Phone:978-399-0061
Mailing Address - Fax:
Practice Address - Street 1:506 GROTON RD
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-6326
Practice Address - Country:US
Practice Address - Phone:978-399-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-07-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant