Provider Demographics
NPI:1891087284
Name:MAKI, JENNIFER JEAN (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JEAN
Last Name:MAKI
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:JEAN
Other - Last Name:ALTENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-C
Mailing Address - Street 1:68 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4614
Mailing Address - Country:US
Mailing Address - Phone:207-563-6623
Mailing Address - Fax:
Practice Address - Street 1:68 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4614
Practice Address - Country:US
Practice Address - Phone:207-563-6623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH075038-23363LA2200X
MECNP111014363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health