Individual
LISA Y BERGMARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
735 WILSON ST, BREWER, ME 04412-1000
(207) 989-1567
(207) 989-2287
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 404-8200
(207) 947-0435
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1434
ME
Other
Enumeration date
09/15/2008
Last updated
05/04/2021
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