Provider Demographics
NPI:1295789329
Name:VIEKMAN, DENISE (NP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:VIEKMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FORE RIVER PKWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-774-9839
Mailing Address - Fax:207-761-2127
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 410
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-774-9839
Practice Address - Fax:207-761-2127
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER037445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES86259Medicare UPIN