Provider Demographics
NPI:1992004618
Name:SIDDALL, DOREEN MUIR (NP)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:MUIR
Last Name:SIDDALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:DOREEN
Other - Middle Name:MUIR
Other - Last Name:SPENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:58 BARIBEAU DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3218
Mailing Address - Country:US
Mailing Address - Phone:207-373-3638
Mailing Address - Fax:207-373-3616
Practice Address - Street 1:58 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3218
Practice Address - Country:US
Practice Address - Phone:207-373-3638
Practice Address - Fax:207-373-3616
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081563363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health