Basic Information
| Provider Information | |||||||||
| NPI: | 1295878023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | DAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042407649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077952800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 ROUTE 30 N | ||||||||
| Address2: | |||||||||
| City: | BOMOSEEN | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057329647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027733386 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | EC161051 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.