Organization
EVERGREEN HEALING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA TREMAINE BRIDGMAN FNP (FAMILY NURSE PRACTITIONER)
(207) 512-0584
Entity
Organization
Contact information
Practice address
224 STATE ST, BANGOR, ME 04401-3434
(207) 512-0584
(207) 990-6604
Mailing address
218 COTTRELL RD, DIXMONT, ME 04932-3246
(207) 512-0584
(207) 234-4334
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
—
—
261QP2300X
Primary Care Clinic/Center
AP081246
ME
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
246520000
—
ME
Enumeration date
12/10/2009
Last updated
10/26/2020
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