Individual
MS. JENNIFER ALICE KOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-0111
Mailing address
818 CONGRESS ST, PORTLAND, ME 04102-3112
(207) 773-8161
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
PA1735
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1142971
NATIONAL COMMISSION ON CERTIFICATION FOR PAS (NCCPA)
—
01
—
PA1735
MAINE BOARD OF LICENSURE IN MEDICINE
ME
Enumeration date
07/24/2017
Last updated
07/21/2022
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