Provider Demographics
NPI:1790947612
Name:STANCU, JENNIE H (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:H
Last Name:STANCU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:97 NEWBURY ST
Mailing Address - Street 2:#2
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4218
Mailing Address - Country:US
Mailing Address - Phone:207-775-2004
Mailing Address - Fax:207-221-2505
Practice Address - Street 1:97 NEWBURY ST
Practice Address - Street 2:#2
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4218
Practice Address - Country:US
Practice Address - Phone:207-775-2004
Practice Address - Fax:207-221-2505
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2478225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist