Provider Demographics
NPI:1477236230
Name:RAYMOND, BRUCE LORNE (RN)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:LORNE
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PREBLE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2426
Mailing Address - Country:US
Mailing Address - Phone:207-523-9276
Mailing Address - Fax:888-245-3952
Practice Address - Street 1:160 PREBLE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2426
Practice Address - Country:US
Practice Address - Phone:207-523-9276
Practice Address - Fax:888-245-3952
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN79259163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)