Healthcare Provider Details

I. General information

NPI: 1689720963
Provider Name (Legal Business Name): NANCY KIESER BRIDGENS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARKET ST STE 300
COLLEGEVILLE PA
19426-4927
US

IV. Provider business mailing address

495 W RIDGE PIKE
LIMERICK PA
19468-1415
US

V. Phone/Fax

Practice location:
  • Phone: 484-622-7940
  • Fax: 484-622-7950
Mailing address:
  • Phone: 610-495-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberOSOO4589L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: