Provider Demographics
NPI:1609425347
Name:DUGGAN, BRENDA MARY (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARY
Last Name:DUGGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 KANSAS RD
Mailing Address - Street 2:
Mailing Address - City:MILBRIDGE
Mailing Address - State:ME
Mailing Address - Zip Code:04658-3120
Mailing Address - Country:US
Mailing Address - Phone:207-546-1576
Mailing Address - Fax:
Practice Address - Street 1:195 KANSAS RD
Practice Address - Street 2:
Practice Address - City:MILBRIDGE
Practice Address - State:ME
Practice Address - Zip Code:04658-3120
Practice Address - Country:US
Practice Address - Phone:207-546-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME46246163WC0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management