Healthcare Provider Details

I. General information

NPI: 1801570098
Provider Name (Legal Business Name): JENNIFER RANCOURT HEARING INSTRUMENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 KENNEDY MEMORIAL DR
WATERVILLE ME
04901-5131
US

IV. Provider business mailing address

105 KENNEDY MEMORIAL DR
WATERVILLE ME
04901-5131
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-0320
  • Fax: 207-872-0330
Mailing address:
  • Phone: 207-872-0320
  • Fax: 207-872-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberDL456
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: