Healthcare Provider Details

I. General information

NPI: 1497309652
Provider Name (Legal Business Name): DOROTHY ELIZABETH ZIRKLE AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 04/05/2020
Certification Date: 04/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 BRAMHALL ST STE GI
PORTLAND ME
04102-3344
US

IV. Provider business mailing address

66 BRAMHALL ST STE GI
PORTLAND ME
04102-3344
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP191182
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: