Provider Demographics
NPI:1750961108
Name:LEDOUX, JENNIFER ASHLEY (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ASHLEY
Last Name:LEDOUX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SUMMIT TER APT 21
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2208
Mailing Address - Country:US
Mailing Address - Phone:413-378-0592
Mailing Address - Fax:
Practice Address - Street 1:2300 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1908
Practice Address - Country:US
Practice Address - Phone:207-221-2297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN72753163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)