Individual
JILL RENEE DUSSEAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-2413
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-2413
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1311
NH
363A00000X
Physician Assistant
Primary
PA2350
ME
Other
Enumeration date
10/09/2017
Last updated
06/28/2022
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