Individual
JESSICA HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
191 MARGINAL WAY STE A, PORTLAND, ME 04101-3387
(207) 517-3838
Mailing address
191 MARGINAL WAY STE A, PORTLAND, ME 04101-3387
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2303
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2303
MAINE LICENSURE
ME
Enumeration date
07/09/2022
Last updated
04/11/2023
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