Healthcare Provider Details

I. General information

NPI: 1285693432
Provider Name (Legal Business Name): ANNETTE O'GORMAN FNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/31/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 ROOSEVELT TRL
WINDHAM ME
04062-4821
US

IV. Provider business mailing address

409 ROOSEVELT TRAIL MERCY WALK-IN CLINIC
WINDHAM ME
04062
US

V. Phone/Fax

Practice location:
  • Phone: 207-400-8600
  • Fax:
Mailing address:
  • Phone: 207-400-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number81383
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: