Provider Demographics
NPI:1023603107
Name:QUIMBY, JENNIFER J (RD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:QUIMBY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-0072
Mailing Address - Country:US
Mailing Address - Phone:207-490-6900
Mailing Address - Fax:207-324-0546
Practice Address - Street 1:15 OAK ST
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1926
Practice Address - Country:US
Practice Address - Phone:207-490-6900
Practice Address - Fax:207-324-0546
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered