Provider Demographics
NPI:1689910325
Name:HIRSHBERG, ROTCHANA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ROTCHANA
Middle Name:
Last Name:HIRSHBERG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ROTCHANA
Other - Middle Name:
Other - Last Name:PETCHDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 GLEN COVE DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856
Mailing Address - Country:US
Mailing Address - Phone:207-921-5800
Mailing Address - Fax:
Practice Address - Street 1:4 GLEN COVE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4235
Practice Address - Country:US
Practice Address - Phone:207-921-5800
Practice Address - Fax:207-921-5332
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP161073363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner