Healthcare Provider Details

I. General information

NPI: 1134309834
Provider Name (Legal Business Name): JANE WINSLOW NICHOLS-ECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE W NICHOLS-ECKER PA-C

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 COLLEGE STA
BRUNSWICK ME
04011-8427
US

IV. Provider business mailing address

67 SIMPSONS POINT RD
BRUNSWICK ME
04011-7905
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-3770
  • Fax:
Mailing address:
  • Phone: 207-729-0926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-299
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: