Healthcare Provider Details

I. General information

NPI: 1760247134
Provider Name (Legal Business Name): TERESA M JAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 SUMMER ST
DOVER FOXCROFT ME
04426-1129
US

IV. Provider business mailing address

529 S PATTEN RD
PATTEN ME
04765-3007
US

V. Phone/Fax

Practice location:
  • Phone: 207-523-3700
  • Fax: 207-528-2880
Mailing address:
  • Phone: 207-538-3700
  • Fax: 207-528-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN50755
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: