Healthcare Provider Details

I. General information

NPI: 1407898489
Provider Name (Legal Business Name): JILL M TERRANOVA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STATE ST
PORTLAND ME
04101-3776
US

IV. Provider business mailing address

144 STATE ST
PORTLAND ME
04101-3776
US

V. Phone/Fax

Practice location:
  • Phone: 207-879-3000
  • Fax:
Mailing address:
  • Phone: 207-879-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR043112
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: