Healthcare Provider Details

I. General information

NPI: 1881171106
Provider Name (Legal Business Name): BETTINA IRMGART HERRICK APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WHITING HILL RD STE 21
BREWER ME
04412-1022
US

IV. Provider business mailing address

43 WHITING HILL RD STE 300
BREWER ME
04412-1006
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-7478
  • Fax: 207-973-7807
Mailing address:
  • Phone: 207-973-5000
  • Fax: 207-973-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP181182
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP181182
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: