Healthcare Provider Details

I. General information

NPI: 1578645511
Provider Name (Legal Business Name): BRIDGET GRACE MORAN RNC, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901NEVIN AVE BUILDING C, 2ND FLOOR
RICHMOND CA
94801
US

IV. Provider business mailing address

6558 KENSINGTON AVE
RICHMOND CA
94805-1660
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-2032
  • Fax:
Mailing address:
  • Phone: 510-233-5285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number244886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: