Individual
MS. LOIS TIEDEKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
84 MARGINAL WAY, SUITE 800, PORTLAND, ME 04101
(207) 774-5816
(207) 523-8595
Mailing address
100 FODEN RD , WEST, STE 203, SOUTH PORTLAND, ME 04106-2327
(207) 828-0361
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
022855
ME
Other
Enumeration date
03/15/2006
Last updated
11/23/2010
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