Provider Demographics
NPI:1134309834
Name:NICHOLS-ECKER, JANE WINSLOW
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:WINSLOW
Last Name:NICHOLS-ECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:W
Other - Last Name:NICHOLS-ECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:67 SIMPSONS POINT RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-7905
Mailing Address - Country:US
Mailing Address - Phone:207-729-0926
Mailing Address - Fax:
Practice Address - Street 1:3600 COLLEGE STA
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-8427
Practice Address - Country:US
Practice Address - Phone:207-725-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant