Provider Demographics
NPI:1679749238
Name:EMERSON, BRENDA LEE SURABIAN (CPM)
Entity Type:Individual
Prefix:MS
First Name:BRENDA LEE
Middle Name:SURABIAN
Last Name:EMERSON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LIMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04049-3709
Mailing Address - Country:US
Mailing Address - Phone:207-329-2111
Mailing Address - Fax:207-637-2346
Practice Address - Street 1:11 RIVER RD
Practice Address - Street 2:
Practice Address - City:LIMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04049-3709
Practice Address - Country:US
Practice Address - Phone:207-329-2111
Practice Address - Fax:207-637-2346
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107-0000032176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife