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General NPI Number Information
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NPI Number | 1902405582
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Entity Type | Individual
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Provider Name | JENNIFER LEIGH REARDON FNP
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Gender | Female
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 193 BATH RD
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City | BRUNSWICK
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State | ME
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Zip | 04011-2607
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Country | US
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Telephone | 207-424-2272
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Fax | 207-424-2268
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Provider Business Mailing Address
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Address Line | 360 US HIGHWAY 1 BYP UNIT 102
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City | PORTSMOUTH
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State | NH
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Zip | 03801-7105
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Country | US
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Telephone | 603-410-6700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP241693
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | 200441874
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 60699055
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10000620
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License Number State | OR
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