Basic Information
Provider Information
NPI: 1659665818
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHMITZ
FirstName: JENNIFER
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SAVAGE
OtherFirstName: JENNIFER
OtherMiddleName: R
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1 MEDICAL CENTER DR
Address2:  
City: BIDDEFORD
State: ME
PostalCode: 040059422
CountryCode: US
TelephoneNumber: 2072837937
FaxNumber: 2072829180
Practice Location
Address1: 1 MEDICAL CENTER DR
Address2:  
City: BIDDEFORD
State: ME
PostalCode: 040059422
CountryCode: US
TelephoneNumber: 2072837937
FaxNumber: 2072829180
Other Information
ProviderEnumerationDate: 06/06/2011
LastUpdateDate: 09/20/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XR047053MEY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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