Individual
JACOB THOMAS WILLIAM RECORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
716 STEVENS AVE, PORTLAND, ME 04103
(207) 221-4516
Mailing address
716 STEVENS AVENUE, PORTLAND, ME 04103
(207) 221-4516
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
RN83209
ME
Other
Enumeration date
08/27/2025
Last updated
08/27/2025
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