Provider Demographics
NPI:1912365727
Name:JERNIGAN, RAYLENE D (CNM)
Entity Type:Individual
Prefix:
First Name:RAYLENE
Middle Name:D
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:RAYLENE
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 STILLWATER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3984
Mailing Address - Country:US
Mailing Address - Phone:207-945-6588
Mailing Address - Fax:207-945-2955
Practice Address - Street 1:12 STILLWATER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3984
Practice Address - Country:US
Practice Address - Phone:207-945-6588
Practice Address - Fax:207-945-2955
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNM3074367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife