Individual
GERALDINE BOGDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNS, NP
Contact information
Practice address
932 CONGRESS ST, PORTLAND, ME 04102-3032
(207) 662-3005
(207) 662-3863
Mailing address
932 CONGRESS ST, PORTLAND, ME 04102-3032
(207) 662-3005
(207) 662-3863
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
R029424
ME
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
R029424
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
432078399
STATE PROVIDER NO.
ME
Enumeration date
11/08/2006
Last updated
12/16/2011
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