Healthcare Provider Details

I. General information

NPI: 1972736577
Provider Name (Legal Business Name): NEWBRIDGE CLINIC P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2009
Last Update Date: 08/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 HUMBOLDT AVE S
BLOOMINGTON MN
55431-1433
US

IV. Provider business mailing address

8200 HUMBOLDT AVE S
BLOOMINGTON MN
55431-1433
US

V. Phone/Fax

Practice location:
  • Phone: 612-730-2237
  • Fax: 206-338-2186
Mailing address:
  • Phone: 612-730-2237
  • Fax: 206-338-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE A BELSETH
Title or Position: DIRECTOR
Credential: CNP
Phone: 612-730-2237