| Doctor Name: | JEREMY JAMES LIBBY |
| NPI Number: | 1609269315 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | CNP151007 |
| Business Practice Address: | 10 Goodall Dr East Waterboro, ME - 040305214 |
| Business Phone Number: | 2074907760 |
| Business Fax Number: | |
| Mailing Address: | 15 Vincent Ave, BIDDEFORD |
| State: | ME |
| Postal Code: | 040053611 |
| Phone Number: | 2076327809 |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2015 |
| NPI Last Update Date: | 03/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | CNP151007 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |