Individual
JENNIFER D MORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102
(207) 948-2100
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102
(207) 861-3338
(207) 873-2385
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP111064
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12079328
CAQHI
—
Enumeration date
07/09/2009
Last updated
12/20/2013
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