Individual
MRS. JESSICA C PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
735 WILSON ST, BREWER, ME 04412
(207) 947-0768
(207) 947-0699
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 945-5247
(207) 947-0435
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP091010
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433873199
—
ME
01
—
AP091010
LICENSE NUMBER MBON
ME
01
—
APN0000013628
APRN LICENSE NUMBER
TN
01
—
MM9086
MEDICARE GROUP NUMBER
ME
Enumeration date
01/29/2009
Last updated
06/22/2010
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