Provider Demographics
NPI:1447780002
Name:PERRY, JAMIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BROADWAY BLDG 1
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1900
Mailing Address - Country:US
Mailing Address - Phone:207-290-7301
Mailing Address - Fax:207-907-3011
Practice Address - Street 1:900 BROADWAY BLDG 1
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-1900
Practice Address - Country:US
Practice Address - Phone:207-907-3010
Practice Address - Fax:207-907-3011
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP171065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner