Healthcare Provider Details

I. General information

NPI: 1831238997
Provider Name (Legal Business Name): JENNIFER YANDOW PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL LN CALAIS REGIONL HOSPITAL
CALAIS ME
04619-1329
US

IV. Provider business mailing address

1345 RIVER RD
CALAIS ME
04619-4202
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-7521
  • Fax:
Mailing address:
  • Phone: 207-214-1296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number009902
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA001265
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: