Healthcare Provider Details

I. General information

NPI: 1396720322
Provider Name (Legal Business Name): BRIDGET ELIZABETH NELSON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
TRIPLER AMC HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
TRIPLER AMC HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-2460
  • Fax: 808-433-5351
Mailing address:
  • Phone: 808-433-2460
  • Fax: 808-433-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number883309
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: