Individual
JENNIFER ODDLEIFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
592 WEST MAIN ST.-, WALDOBORO, ME 04572-6030
(207) 832-6394
(207) 832-4392
Mailing address
PO BOX 745, NEWCASTLE, ME 04553-0745
(207) 563-4511
(207) 563-4103
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA - 289
ME
363A00000X
Physician Assistant
Primary
PA289
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290260099
—
ME
Enumeration date
08/02/2005
Last updated
02/20/2014
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