Healthcare Provider Details

I. General information

NPI: 1003175530
Provider Name (Legal Business Name): BRIDGET COLLEEN WU CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 FIRESIDE TRL
BROADVIEW HTS OH
44147-3626
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195
US

V. Phone/Fax

Practice location:
  • Phone: 216-312-3721
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN324976
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: