Healthcare Provider Details

I. General information

NPI: 1225181555
Provider Name (Legal Business Name): MORGAN JENNIE TITUS RAU N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MAPLE ST # 3
VASSALBORO ME
04989-3129
US

IV. Provider business mailing address

36 MAPLE ST # 3
VASSALBORO ME
04989-3129
US

V. Phone/Fax

Practice location:
  • Phone: 207-469-5534
  • Fax: 207-873-3924
Mailing address:
  • Phone: 207-469-5534
  • Fax: 207-873-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP288
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: