Provider Demographics
NPI:1093316796
Name:BANNISTER, JAMIE DAWN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DAWN
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6038
Mailing Address - Country:US
Mailing Address - Phone:207-577-9426
Mailing Address - Fax:
Practice Address - Street 1:409 ALFRED ST STE 4-5
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3756
Practice Address - Country:US
Practice Address - Phone:207-346-5807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN61568163WP0808X
MECNP221277363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health