Healthcare Provider Details

I. General information

NPI: 1033551890
Provider Name (Legal Business Name): DONNA MARIE BRIDGER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 TWO NOTCH RD
LEXINGTON SC
29072-7963
US

IV. Provider business mailing address

2480 TWO NOTCH RD
LEXINGTON SC
29072-7963
US

V. Phone/Fax

Practice location:
  • Phone: 803-951-5871
  • Fax: 803-951-5882
Mailing address:
  • Phone: 803-951-5871
  • Fax: 803-951-5882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170752
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN18697
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45951
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: