Provider Demographics
NPI:1376632125
Name:PAKULSKI, RITA MARGARET (RN-C)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:MARGARET
Last Name:PAKULSKI
Suffix:
Gender:F
Credentials:RN-C
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:MARGARET
Other - Last Name:CRUDDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8160
Mailing Address - Country:US
Mailing Address - Phone:207-248-0097
Mailing Address - Fax:207-248-0094
Practice Address - Street 1:35 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8160
Practice Address - Country:US
Practice Address - Phone:207-248-0097
Practice Address - Fax:207-248-0094
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER037173163WP0808X
MECNP211339363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME254150099Medicaid