Individual provider · NPI-1

Heather Elisabeth Bacon, CNM

Advanced Practice Midwife · Portland, ME

NPI number1235261389
StatusActive
Last updated in NPPESAug 6, 2015

Details

NPI
1235261389
Entity type
Individual (NPI-1)
Name
Ms. Heather Elisabeth Bacon
Credential
CNM
Sex
Female
Sole proprietor
No
Enumeration date
Mar 12, 2007
Last updated
Aug 6, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
367A00000X Advanced Practice Midwife––Yes
163WC1500X Registered Nurse, Community Health622397CA

Practice location

163 Edwards St
Portland, ME 04102-2539

Phone 619-401-3712

Mailing address

163 Edwards St
Portland, ME 04102-2539

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