Provider Demographics
NPI:1528583267
Name:KLAUER, JESSIE E (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:E
Last Name:KLAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1099
Mailing Address - Country:US
Mailing Address - Phone:207-363-4321
Mailing Address - Fax:207-363-0120
Practice Address - Street 1:15 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1011
Practice Address - Country:US
Practice Address - Phone:073-634-4321
Practice Address - Fax:207-363-0120
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6178363A00000X
MEPA2241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110028739AMedicaid