Healthcare Provider Details

I. General information

NPI: 1376632125
Provider Name (Legal Business Name): RITA MARGARET PAKULSKI RN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITA MARGARET CRUDDEN

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-248-0097
  • Fax: 207-248-0094
Mailing address:
  • Phone: 207-248-0097
  • Fax: 207-248-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR037173
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP211339
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: