Provider Demographics
NPI:1033483433
Name:JACQUES, MEGHAN L (PAC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:L
Last Name:JACQUES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:L
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:
Practice Address - Street 1:ONE NORTHEAST DRIVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-275-3800
Practice Address - Fax:207-275-3803
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1316363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical