Provider Demographics
NPI:1336592062
Name:LIZEWSKI, JENNA L (CNP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:LIZEWSKI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:L
Other - Last Name:LIZEWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:529 US-1
Mailing Address - Street 2:SUITE 104
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1099
Mailing Address - Country:US
Mailing Address - Phone:207-200-1338
Mailing Address - Fax:207-221-7689
Practice Address - Street 1:529 US-1
Practice Address - Street 2:SUITE 104
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909
Practice Address - Country:US
Practice Address - Phone:207-200-1338
Practice Address - Fax:207-200-1338
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily