Provider Demographics
NPI:1598953309
Name:SULKA-MEISTER, DEIRDRE (FNP)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:
Last Name:SULKA-MEISTER
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 1:100 BRICKHILL AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1999
Mailing Address - Country:US
Mailing Address - Phone:207-761-4700
Mailing Address - Fax:207-761-4744
Practice Address - Street 1:100 BRICKHILL AVE
Practice Address - Street 2:STE 304
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1999
Practice Address - Country:US
Practice Address - Phone:207-761-4700
Practice Address - Fax:207-761-4744
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
MECNP111057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife