Provider Demographics
NPI:1710390711
Name:MARTINI, JENNA (DO)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MARTINI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:MAWHINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-0727
Mailing Address - Country:US
Mailing Address - Phone:207-495-3323
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:4 CLEMENT WAY
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:ME
Practice Address - Zip Code:04917-4370
Practice Address - Country:US
Practice Address - Phone:207-495-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3445204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine