Basic Information
| Provider Information | |||||||||
| NPI: | 1487713012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERGMANS | ||||||||
| FirstName: | LOIS | ||||||||
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| Credential: | MSN, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 417 STATE ST | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079734670 | ||||||||
| FaxNumber: | 2079734669 | ||||||||
| Practice Location | |||||||||
| Address1: | 417 STATE ST | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079734670 | ||||||||
| FaxNumber: | 2079734669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 044376 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.