Healthcare Provider Details

I. General information

NPI: 1417944455
Provider Name (Legal Business Name): AMY LYNNE BERGERON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 BARRA RD STE 201202
BIDDEFORD ME
04005-9459
US

IV. Provider business mailing address

46 BARRA RD STE 201202
BIDDEFORD ME
04005-9459
US

V. Phone/Fax

Practice location:
  • Phone: 207-282-3349
  • Fax: 207-294-3541
Mailing address:
  • Phone: 207-282-3349
  • Fax: 207-294-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP81508
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP81508
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: