Individual
MRS. JACLYN KIMBERLY FORAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
360 BROADWAY, BANGOR, ME 04401-3979
(207) 907-1155
(207) 907-1888
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8941
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP201144
ME
363LX0106X
Occupational Health Nurse Practitioner
CNP201144
ME
Other
Enumeration date
06/22/2020
Last updated
02/21/2022
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