Individual
JESSICA A VERRILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
118 MAINE MALL RD, SUITE 3, SOUTH PORTLAND, ME 04106-2309
(207) 899-0222
Mailing address
269 DINGLEY SPRING RD, GORHAM, ME 04038-2169
(207) 899-0222
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT2532
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099083
ANTHEM
ME
01
—
1992829162
AETNA
ME
Enumeration date
04/03/2007
Last updated
03/28/2016
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