Provider Demographics
NPI:1245435965
Name:HENEY-BERGEN, MARGARET A (CRNA)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:HENEY-BERGEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:A
Other - Last Name:HENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:DEPT OF ANESTHESIOLOGY
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-662-4562
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-4562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224234163W00000X
MA45042367500000X
MER035936367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000849901Medicare PIN