Healthcare Provider Details

I. General information

NPI: 1700407897
Provider Name (Legal Business Name): DOROTHY ANN ZIRKLE CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 HEMLOCK LN
FALMOUTH ME
04105-1156
US

IV. Provider business mailing address

13 HEMLOCK LN
FALMOUTH ME
04105-1156
US

V. Phone/Fax

Practice location:
  • Phone: 918-629-8931
  • Fax:
Mailing address:
  • Phone: 918-629-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2258140
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: