Provider Demographics
NPI:1437381084
Name:VANDER SCHAAF, DEIRDRE R (FNP)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:R
Last Name:VANDER SCHAAF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MAIN STREET
Mailing Address - Street 2:SHEEPSCOT VALLEY HEALTH CENTER
Mailing Address - City:COOPERS MILLS
Mailing Address - State:ME
Mailing Address - Zip Code:04341
Mailing Address - Country:US
Mailing Address - Phone:207-549-7581
Mailing Address - Fax:207-549-3439
Practice Address - Street 1:47 MAIN STREET
Practice Address - Street 2:SHEEPSCOT VALLEY HEALTH CENTER
Practice Address - City:COOPERS MILLS
Practice Address - State:ME
Practice Address - Zip Code:04341
Practice Address - Country:US
Practice Address - Phone:207-549-7581
Practice Address - Fax:207-549-3439
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP91043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434717099Medicaid
ME434717099Medicaid