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NPI Code Detail

MEDICARE: THERESA M JACQUES FNP-C

MEDICARE: THERESA M JACQUES FNP-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
1363L00000XNurse PractitionerR023315ME

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4500006987OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101-0443255OTHERCIGNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3098281OTHERMEANTHEM

General Provider Information

NPI Number : 1881647709
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA M JACQUES FNP-C
Provider Business Mailing Address
First Line : PO BOX 247
Second Line :
City : NORTH VASSALBORO
State : ME
Zip : 04962-0247
Country : US
Telephone Number : 207-873-1098
Fax Number : 207-873-4514
Provider Business Practice Location Address
First Line : 80 GARLAND RD
Second Line :
City : WINSLOW
State : ME
Zip : 04901-0600
Country : US
Telephone Number : 207-873-1098
Fax Number : 207-873-4514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 05/05/2008

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Directions to “ THERESA M JACQUES FNP-C” Practice Location

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