Healthcare Provider Details

I. General information

NPI: 1891477964
Provider Name (Legal Business Name): JORDAN J. PEELER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FODEN RD STE 203
SOUTH PORTLAND ME
04106-2327
US

IV. Provider business mailing address

100 GANNETT DR STE C
SOUTH PORTLAND ME
04106-5900
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-1489
  • Fax: 207-523-8590
Mailing address:
  • Phone: 207-828-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP231339
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: