Provider Demographics
NPI:1821350067
Name:BRONSON, KATHRYN WISTAR MYERS (CPM)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:WISTAR MYERS
Last Name:BRONSON
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 1:91 UNION ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2019
Mailing Address - Country:US
Mailing Address - Phone:207-322-1277
Mailing Address - Fax:
Practice Address - Street 1:91 UNION ST
Practice Address - Street 2:APT 1
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2019
Practice Address - Country:US
Practice Address - Phone:207-322-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife