Healthcare Provider Details

I. General information

NPI: 1174156202
Provider Name (Legal Business Name): DANIELLE LYNN JAMISON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 CAMPUS AVE STE 301
LEWISTON ME
04240-6045
US

IV. Provider business mailing address

99 CAMPUS AVE STE 301
LEWISTON ME
04240-6045
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-5300
  • Fax: 207-777-1276
Mailing address:
  • Phone: 207-777-5300
  • Fax: 207-777-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP201005
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP201005
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: