Healthcare Provider Details

I. General information

NPI: 1073247367
Provider Name (Legal Business Name): LAUREN JELLISON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 ROUTE 2
HERMON ME
04401-0609
US

IV. Provider business mailing address

2423 ROUTE 2
HERMON ME
04401-0609
US

V. Phone/Fax

Practice location:
  • Phone: 207-742-2839
  • Fax: 207-835-4058
Mailing address:
  • Phone: 207-742-2839
  • Fax: 207-835-4058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP221225
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: