Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 21455 | NH |
Y | 207RC0000X | Internist - Cardiovascular Disease | MD24474 | ME |
NPI | 1023405479 |
---|---|
Provider Name | Dr. Jessica Ana Kvasic |
First Address | Lewiston, ME 04240-6045 |
Second Address | Lewiston, ME 04240-6045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 10/06/2021 |