Individual
JENNY T PISCULLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
149 NORTH ST, WATERVILLE, ME 04901-4974
(207) 861-5000
(207) 861-5001
Mailing address
149 NORTH ST, WATERVILLE, ME 04901-4974
(207) 861-5000
(207) 861-5001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
017231
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432678699
—
ME
Enumeration date
07/06/2006
Last updated
05/31/2019
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