1003015025 NPI number — MRS. JENNIFER ANNE DREHER ANP-C, RN

Table of content: MRS. JENNIFER ANNE DREHER ANP-C, RN (NPI 1003015025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003015025 NPI number — MRS. JENNIFER ANNE DREHER ANP-C, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DREHER
Provider First Name:
JENNIFER
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP-C, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUSHMAN
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003015025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 GLEN COVE DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ROCKPORT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04856-4235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-593-5800
Provider Business Mailing Address Fax Number:
207-593-5322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 GLEN COVE DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ROCKPORT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04856-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-593-5800
Provider Business Practice Location Address Fax Number:
207-593-5322
Provider Enumeration Date:
07/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  AP081813 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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