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General NPI Number Information
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NPI Number | 1992826192
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Entity Type | Individual
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Provider Name | JESSICA A VERRILL MT
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 118 MAINE MALL RD SUITE 3
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2309
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Country | US
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Telephone | 207-899-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 269 DINGLEY SPRING RD
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City | GORHAM
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State | ME
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Zip | 04038-2169
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Country | US
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Telephone | 207-899-0222
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MT2532
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License Number State | ME
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