Healthcare Provider Details

I. General information

NPI: 1124356860
Provider Name (Legal Business Name): KATHERINE JEWETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN ST
LEWISTON ME
04240-5938
US

IV. Provider business mailing address

800 CENTER ST
AUBURN ME
04210-6404
US

V. Phone/Fax

Practice location:
  • Phone: 207-782-2726
  • Fax: 207-333-3501
Mailing address:
  • Phone: 207-782-2726
  • Fax: 207-333-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT2180
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: