Provider Demographics
NPI:1518037910
Name:EIMICKE, TONI M (PNP)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:M
Last Name:EIMICKE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:M
Other - Last Name:DEMETRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:SUITE C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:887 CONGRESS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-5522
Practice Address - Fax:207-662-5527
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381826363LP0200X
DCRN1011978363LP0200X
MEAP091045363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001858701Medicare PIN