Provider Demographics
NPI:1285693432
Name:O'GORMAN, ANNETTE (FNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:O'GORMAN
Suffix:
Gender:
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 ROOSEVELT TRAIL
Mailing Address - Street 2:MERCY WALK-IN CLINIC
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062
Mailing Address - Country:US
Mailing Address - Phone:207-400-8600
Mailing Address - Fax:
Practice Address - Street 1:409 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4821
Practice Address - Country:US
Practice Address - Phone:207-400-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME81383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102380100Medicaid
ME154420000Medicaid
ME434093299Medicaid
MENP439101OtherMED B - PERS FOR 200051
MENP439102Medicare PIN
MENP4391Medicare ID - Type Unspecified
ME201300Medicare ID - Type UnspecifiedMEDICARE A - BHMH
ME154420000Medicaid
MENP439101OtherMED B - PERS FOR 200051