Healthcare Provider Details

I. General information

NPI: 1598801532
Provider Name (Legal Business Name): BRIDGET LAREW FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FAIRMONT RD
WESTOVER WV
26501-3847
US

IV. Provider business mailing address

4212 MILLINGTON RD
PITTSBURGH PA
15217-2852
US

V. Phone/Fax

Practice location:
  • Phone: 304-292-7316
  • Fax:
Mailing address:
  • Phone: 301-503-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0320590-22
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: