Provider Demographics
NPI:1700435807
Name:CRUTSINGER, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:CRUTSINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARNOIS AVE.
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092
Mailing Address - Country:US
Mailing Address - Phone:207-662-1340
Mailing Address - Fax:
Practice Address - Street 1:1 HARNOIS AVE.
Practice Address - Street 2:SUITE 1B
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092
Practice Address - Country:US
Practice Address - Phone:207-662-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231267363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner