Provider Demographics
NPI:1871782086
Name:BEAN, JENNIFER LEE (RN, PHN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:BEAN
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 BATH RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2673
Mailing Address - Country:US
Mailing Address - Phone:207-373-3099
Mailing Address - Fax:207-373-3098
Practice Address - Street 1:329 BATH RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2673
Practice Address - Country:US
Practice Address - Phone:207-373-3099
Practice Address - Fax:207-373-3098
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER052167163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse