Healthcare Provider Details

I. General information

NPI: 1699694943
Provider Name (Legal Business Name): BRIDGET RENE MCILWAIN CCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 LONGMEADOW RD
NORTH AUGUSTA SC
29860-9246
US

IV. Provider business mailing address

222 LONGMEADOW RD
NORTH AUGUSTA SC
29860-9246
US

V. Phone/Fax

Practice location:
  • Phone: 808-295-5735
  • Fax:
Mailing address:
  • Phone: 808-295-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberAP119893
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: