Provider Demographics
NPI:1447548698
Name:CAUDELL, JASON DANIEL (NP-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:DANIEL
Last Name:CAUDELL
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 MAIN ST
Mailing Address - Street 2:PO BOX 746
Mailing Address - City:BINGHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04920-0746
Mailing Address - Country:US
Mailing Address - Phone:207-672-4187
Mailing Address - Fax:
Practice Address - Street 1:237 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAM
Practice Address - State:ME
Practice Address - Zip Code:04920-0746
Practice Address - Country:US
Practice Address - Phone:207-672-4187
Practice Address - Fax:207-672-3641
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP161095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily