Healthcare Provider Details

I. General information

NPI: 1336218684
Provider Name (Legal Business Name): GERALDINE BOGDAN CNS, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 CONGRESS ST
PORTLAND ME
04102-3032
US

IV. Provider business mailing address

932 CONGRESS ST
PORTLAND ME
04102-3032
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-3005
  • Fax: 207-662-3863
Mailing address:
  • Phone: 207-662-3005
  • Fax: 207-662-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR029424
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR029424
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: