Healthcare Provider Details

I. General information

NPI: 1639605066
Provider Name (Legal Business Name): BRIDGET WEST RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/09/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S ARMY HEALTH CLINIC VILSECK UNIT 23807
APO AE
09112
US

IV. Provider business mailing address

3421 MACKLAND AVE NE
ALBUQUERQUE NM
87106-1216
US

V. Phone/Fax

Practice location:
  • Phone: 490-637-1946
  • Fax:
Mailing address:
  • Phone: 505-265-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86038482
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: