Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 1822 | ME |
NPI | 1215010889 |
---|---|
Provider Name | Charmaine B Jensen |
First Address | Lincolnville, ME 04849-5310 |
Second Address | Lincolnville, ME 04849-5310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 28/01/2013 |