Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 017911 | ME |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD17911 | ME |
NPI | 1750549044 |
---|---|
Provider Name | Dr. Samuela Eudora Manages |
First Address | Caribou, ME 04736-0040 |
Second Address | Van Buren, ME 04785-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2008 |
Last Update Date | 15/09/2021 |