=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922069376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER GUILFOYLE FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2006
-----------------------------------------------------
Last Update Date | 09/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 GLEN COVE DR STE 202
-----------------------------------------------------
City | ROCKPORT
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-596-9911
-----------------------------------------------------
Fax | 209-586-9955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 GLEN COVE DR STE 202
-----------------------------------------------------
City | ROCKPORT
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-596-9911
-----------------------------------------------------
Fax | 209-586-9955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R047928
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------