Provider Demographics
NPI:1780472290
Name:GRANT, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GRANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:POLAND SPRING
Mailing Address - State:ME
Mailing Address - Zip Code:04274-6111
Mailing Address - Country:US
Mailing Address - Phone:207-786-2411
Mailing Address - Fax:207-786-2411
Practice Address - Street 1:1184 MAINE ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274-6719
Practice Address - Country:US
Practice Address - Phone:207-899-9988
Practice Address - Fax:207-899-9988
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other