Provider Demographics
NPI:1790014967
Name:MEADER, NICOLE L
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:MEADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:HILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 REBECCA ST
Mailing Address - Street 2:
Mailing Address - City:NORRIDGEWOCK
Mailing Address - State:ME
Mailing Address - Zip Code:04957-3927
Mailing Address - Country:US
Mailing Address - Phone:207-431-4766
Mailing Address - Fax:
Practice Address - Street 1:78 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1221
Practice Address - Country:US
Practice Address - Phone:207-858-4860
Practice Address - Fax:207-858-4864
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434529099Medicaid