MEDICARE: LAURA T. BRIDGMAN F.N.P., N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R026043	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043315658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA T. BRIDGMAN F.N.P., N.D.

Provider Business Mailing Address
First Line	:	268 STATE ST
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-5417
Country	:	US
Telephone Number	:	207-512-0584
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 COTTRELL RD
Second Line	:
City	:	DIXMONT
State	:	ME
Zip	:	04932-3246
Country	:	US
Telephone Number	:	207-512-0584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	02/04/2016

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