Provider Demographics
NPI:1740685908
Name:MARDEN, JILLIAN MAGEE (PA-C, RD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MAGEE
Last Name:MARDEN
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:MAGEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, RD
Mailing Address - Street 1:9 HEALTHCARE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9450
Mailing Address - Country:US
Mailing Address - Phone:207-284-2630
Mailing Address - Fax:207-294-3566
Practice Address - Street 1:9 HEALTHCARE DR STE 204
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9450
Practice Address - Country:US
Practice Address - Phone:207-284-2630
Practice Address - Fax:207-294-3566
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANU3720133V00000X
MEPAN1949363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered