Healthcare Provider Details

I. General information

NPI: 1922338698
Provider Name (Legal Business Name): BRIDGET ERIN PENICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIDGET ERIN GRIMES

II. Dates (important events)

Enumeration Date: 01/02/2010
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-2992
  • Fax: 435-688-6222
Mailing address:
  • Phone: 435-632-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number268585-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: