Individual
JACOB PATRICK LEIDHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-4618
(207) 662-6254
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-4618
(207) 662-6254
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN2361554
MA
363LA2100X
Acute Care Nurse Practitioner
Primary
CNP231268
ME
363LA2100X
Acute Care Nurse Practitioner
RN2361554
MA
Other
Enumeration date
11/23/2021
Last updated
02/24/2026
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