Healthcare Provider Details

I. General information

NPI: 1912488149
Provider Name (Legal Business Name): JARED J MORIN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2018
Last Update Date: 08/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HIGH ST
LEWISTON ME
04240-7676
US

IV. Provider business mailing address

48 EIGHTH ST
AUBURN ME
04210-5626
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-5730
  • Fax:
Mailing address:
  • Phone: 207-240-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP181212
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: