Provider Demographics
NPI:1629518519
Name:PIACENTINI, JAMIE LOWERY
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LOWERY
Last Name:PIACENTINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NEW HAMPSHIRE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2864
Mailing Address - Country:US
Mailing Address - Phone:207-770-5621
Mailing Address - Fax:
Practice Address - Street 1:71 US ROUTE 1 STE J
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7168
Practice Address - Country:US
Practice Address - Phone:207-770-5621
Practice Address - Fax:207-203-4875
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH075242-23363LF0000X
MECNP181259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily