Healthcare Provider Details

I. General information

NPI: 1134990005
Provider Name (Legal Business Name): JENNIFER MERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 NORTH ST
WATERVILLE ME
04901-4974
US

IV. Provider business mailing address

518 FAIRFIELD ST
OAKLAND ME
04963-5217
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN52259
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: