Provider Demographics
NPI:1154451482
Name:BERNIER, AMIE HELEN (LAC MSOM)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:HELEN
Last Name:BERNIER
Suffix:
Gender:F
Credentials:LAC MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FODEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1717
Mailing Address - Country:US
Mailing Address - Phone:207-879-0442
Mailing Address - Fax:
Practice Address - Street 1:55 FODEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1717
Practice Address - Country:US
Practice Address - Phone:207-879-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist