Provider Demographics
NPI:1497751812
Name:MEAKER, NELSON E (PA-C)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:E
Last Name:MEAKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 CORPORATE DR STE 5
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4312
Mailing Address - Country:US
Mailing Address - Phone:207-942-7650
Mailing Address - Fax:207-990-5583
Practice Address - Street 1:133 CORPORATE DR STE 5
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4312
Practice Address - Country:US
Practice Address - Phone:207-942-7650
Practice Address - Fax:207-990-5583
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA 698363AM0700X
MEPA-698363AS0400X
363AS0400X
MEPA252A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME299620099Medicaid
MES55387Medicare UPIN
ME299620099Medicaid
AP1385Medicare PIN
S55387Medicare UPIN