Provider Demographics
NPI:1912479320
Name:DANFORTH, JANE A
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:DANFORTH
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 1:200 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1298
Mailing Address - Country:US
Mailing Address - Phone:207-723-5288
Mailing Address - Fax:207-723-7435
Practice Address - Street 1:200 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1298
Practice Address - Country:US
Practice Address - Phone:207-723-5288
Practice Address - Fax:207-723-7435
Is Sole Proprietor?:No
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator