MEDICARE: JENNIFER ODDLEIFSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA - 289	ME
2	363A00000X	Physician Assistant	PA289	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013918036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ODDLEIFSON PA-C

Provider Business Mailing Address
First Line	:	PO BOX 745
Second Line	:
City	:	NEWCASTLE
State	:	ME
Zip	:	04553-0745
Country	:	US
Telephone Number	:	207-563-4511
Fax Number	:	207-563-4103

Provider Business Practice Location Address
First Line	:	592 WEST MAIN ST.-
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572-6030
Country	:	US
Telephone Number	:	207-832-6394
Fax Number	:	207-832-4392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/20/2014

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