Healthcare Provider Details

I. General information

NPI: 1639636905
Provider Name (Legal Business Name): BRIDGET ELIZABETH WAREHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 LOMA VISTA RD STE 205
VENTURA CA
93003-1582
US

IV. Provider business mailing address

9790 RHONE ST
VENTURA CA
93004-3078
US

V. Phone/Fax

Practice location:
  • Phone: 805-585-3086
  • Fax: 805-653-0616
Mailing address:
  • Phone: 805-585-3086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: