Basic Information
| Provider Information | |||||||||
| NPI: | 1558317859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREDENBERG | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | PHD,NPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 FOX HILL RD | ||||||||
| Address2: | |||||||||
| City: | CAPE ELIZABETH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041072007 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 LANCASTER ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041012418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077722133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 363L00000X | R034441 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 047769 | 01 | ME | BC/BS | OTHER |