Provider Demographics
NPI:1487713012
Name:BERGMANS, LOIS (MSN, CNM)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:BERGMANS
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 STATE ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6630
Mailing Address - Country:US
Mailing Address - Phone:207-973-4670
Mailing Address - Fax:207-973-4669
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:SUITE 340
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6630
Practice Address - Country:US
Practice Address - Phone:207-973-4670
Practice Address - Fax:207-973-4669
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME044376367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife