Provider Demographics
NPI:1356927073
Name:NIELSEN, DEIRDRE M
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:M
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2073
Mailing Address - Country:US
Mailing Address - Phone:207-781-3754
Mailing Address - Fax:
Practice Address - Street 1:206 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2073
Practice Address - Country:US
Practice Address - Phone:207-781-3754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR45241835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care