Healthcare Provider Details

I. General information

NPI: 1023092392
Provider Name (Legal Business Name): MARLENE I BRIDGFORTH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLENE I MIUS ARNP

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S CEDAR ST #301 CARDIAC STUDY CENTER INC PS
TACOMA WA
98405-2308
US

IV. Provider business mailing address

1901 S CEDAR ST #301 CARDIAC STUDY CENTER INC PS
TACOMA WA
98405-2308
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-7320
  • Fax: 253-627-3191
Mailing address:
  • Phone: 253-572-7320
  • Fax: 253-627-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30004776
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: