Provider Demographics
NPI:1851673503
Name:KNOWLTON, JAIME REUTER (PA-C)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:REUTER
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYNN
Other - Last Name:REUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:364 PRITHAM AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04441-7214
Mailing Address - Country:US
Mailing Address - Phone:207-695-5220
Mailing Address - Fax:207-695-5234
Practice Address - Street 1:364 PRITHAM AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:ME
Practice Address - Zip Code:04441-7214
Practice Address - Country:US
Practice Address - Phone:207-695-5220
Practice Address - Fax:207-695-5234
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4971363A00000X
LA200606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant