Individual
ANNETTE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 SOUTHBOROUGH DR, SOUTH PORTLAND, ME 04106-3249
(207) 761-1100
Mailing address
400 SOUTHBOROUGH DR, SOUTH PORTLAND, ME 04106-3249
(207) 761-1100
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MT2272
ME
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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