Healthcare Provider Details

I. General information

NPI: 1518037910
Provider Name (Legal Business Name): TONI M EIMICKE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI M DEMETRI PNP

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST SUITE 100
PORTLAND ME
04102
US

IV. Provider business mailing address

301 US ROUTE 1 SUITE C
SCARBOROUGH ME
04074-7609
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-5522
  • Fax: 207-662-5527
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381826
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN1011978
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP091045
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: