=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881500320
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENOVA HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2026
-----------------------------------------------------
Last Update Date | 08/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 ABBOTT ST STE 12
-----------------------------------------------------
City | BREWER
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04412-2291
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-631-6141
-----------------------------------------------------
Fax | 207-433-1511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2023 HEMLOCK DR
-----------------------------------------------------
City | HERMON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-0274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-631-6141
-----------------------------------------------------
Fax | 207-433-1511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAIME WILLIAMS
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 207-478-2778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------