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NPI Code Detail

MEDICARE: BRIDGID NEPTUNE NP

MEDICARE: BRIDGID NEPTUNE NP
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
1363LF0000XFamily Nurse PractitionerCNP171052ME

General Provider Information

NPI Number : 1831619170
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIDGID NEPTUNE NP
Provider Business Mailing Address
First Line : 39 PINE ST APT 1
Second Line :
City : PORTLAND
State : ME
Zip : 04102-5302
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 CAMPUS DR UNIT 107
Second Line :
City : SCARBOROUGH
State : ME
Zip : 04074-7172
Country : US
Telephone Number : 207-396-7683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2017
Last Update Date : 11/30/2017

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