Provider Demographics
NPI:1043315658
Name:BRIDGMAN, LAURA T (FNP, ND)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:T
Last Name:BRIDGMAN
Suffix:
Gender:F
Credentials:FNP, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5417
Mailing Address - Country:US
Mailing Address - Phone:207-512-0584
Mailing Address - Fax:
Practice Address - Street 1:218 COTTRELL RD
Practice Address - Street 2:
Practice Address - City:DIXMONT
Practice Address - State:ME
Practice Address - Zip Code:04932-3246
Practice Address - Country:US
Practice Address - Phone:207-512-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER026043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME246520000Medicaid
ME246520000Medicaid
MES26330Medicare UPIN