Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | CNP211264 | ME |
NPI | 1003255746 |
---|---|
Provider Name | Jessica Lyn Krol |
First Address | Waterville, ME 04903-0727 |
Second Address | Richmond, ME 04357-1347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2013 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2021015360 | ANCC (FNP-C) (01) | ME |
CNP211264 | MAINE STATE BOARD OF NURSING (01) | ME |
F06210742 | AANP (FNP-BC) (01) | ME |