Basic Information
| Provider Information | |||||||||
| NPI: | 1841603537 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JERGESEN | ||||||||
| FirstName: | ANDREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 HAVERHILL ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018412884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786860900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 149 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049014974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078615101 | ||||||||
| FaxNumber: | 2078724341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2014 | ||||||||
| LastUpdateDate: | 07/27/2018 | ||||||||
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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 | 207Q00000X | DO2796 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.