Provider Demographics
NPI:1568799831
Name:KAUFMAN, JODIE B (CNM, FNP-C)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:B
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:CNM, 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:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-0195
Mailing Address - Country:US
Mailing Address - Phone:207-615-6313
Mailing Address - Fax:207-543-4207
Practice Address - Street 1:5 PIXIE GRV
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6913
Practice Address - Country:US
Practice Address - Phone:207-615-6313
Practice Address - Fax:207-543-4207
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-07
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAM112009367A00000X
MECNP121018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1568799831OtherNPI
ME1568799831Medicaid
MA1568799831OtherNPI