Healthcare Provider Details

I. General information

NPI: 1881500320
Provider Name (Legal Business Name): RENOVA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 ABBOTT ST STE 12
BREWER ME
04412-2291
US

IV. Provider business mailing address

2023 HEMLOCK DR
HERMON ME
04401-0274
US

V. Phone/Fax

Practice location:
  • Phone: 207-631-6141
  • Fax: 207-433-1511
Mailing address:
  • Phone: 207-631-6141
  • Fax: 207-433-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAIME WILLIAMS
Title or Position: OWNER
Credential: FNP
Phone: 207-478-2778