Provider Demographics
NPI:1013384858
Name:CURTIS, MEREDITH L (AG PCNP-BC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:CURTIS
Suffix:
Gender:F
Credentials:AG PCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 WESTERN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2415
Mailing Address - Country:US
Mailing Address - Phone:207-661-0200
Mailing Address - Fax:
Practice Address - Street 1:265 WESTERN AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2415
Practice Address - Country:US
Practice Address - Phone:207-661-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307488363LA2200X
MARN2291614363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health