Basic Information
| Provider Information | |||||||||
| NPI: | 1154430023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | APRN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 HOSPITAL DR | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039091011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073512478 | ||||||||
| FaxNumber: | 2073512153 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 SANFORD RD | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | WELLS | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040905533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076418044 | ||||||||
| FaxNumber: | 2078541516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 12/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 048539 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 010212444 | 01 | ME | TAX ID # | OTHER | 1699860270 | 01 | ME | GROUP NPI # | OTHER | 432036099 | 05 | ME | MEDICAID | 100142 | 01 | ME | ANTHEM | OTHER | 1154430023 | 01 | ME | INDIVIDUAL NPI # | OTHER |