Individual
THERESA M JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
80 GARLAND RD, WINSLOW, ME 04901-0600
(207) 873-1098
(207) 873-4514
Mailing address
PO BOX 247, NORTH VASSALBORO, ME 04962-0247
(207) 873-1098
(207) 873-4514
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R023315
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-0443255
CIGNA
—
01
—
098281
ANTHEM
ME
05
—
283350099
—
ME
01
—
500006987
RAILROAD MEDICARE
—
Enumeration date
05/19/2006
Last updated
05/05/2008
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