Provider Demographics
NPI:1629033790
Name:TILDEN, JESSIE K (CNM)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:K
Last Name:TILDEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:K
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:330 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1636
Mailing Address - Country:US
Mailing Address - Phone:207-288-8100
Mailing Address - Fax:207-801-5124
Practice Address - Street 1:330 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1636
Practice Address - Country:US
Practice Address - Phone:207-288-8100
Practice Address - Fax:207-801-5124
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNM92002176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001343101Medicare UPIN