Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1915 | ME |
N | 207Q00000X | Family Doctor | 1915 | ME |
NPI | 1245323104 |
---|---|
Provider Name | Jennifer A Trimble |
First Address | Bangor, ME 04402-1599 |
Second Address | Bangor, ME 04401-2311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432026899 | (05) | ME |