Provider Demographics
NPI:1356437453
Name:MADORE, JENIFER L (FNP)
Entity type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:L
Last Name:MADORE
Suffix:
Gender:F
Credentials:FNP
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 1638
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1638
Mailing Address - Country:US
Mailing Address - Phone:207-777-4111
Mailing Address - Fax:207-783-6660
Practice Address - Street 1:100 CAMPUS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6040
Practice Address - Country:US
Practice Address - Phone:207-777-4100
Practice Address - Fax:207-777-8994
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME25878099Medicaid
ME25878099Medicaid
ME25878099Medicaid