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General NPI Number Information
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NPI Number | 1073080313
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Entity Type | Organization
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Legal Business Name | BRIDGEWELL MEDICAL, INC.
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 07/29/2023
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Provider Practice Location Address
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Address Line | 800 W MAIN ST SUITE 1460
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City | BOISE
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State | ID
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Zip | 83702-9030
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Country | US
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Telephone | 208-505-1179
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6795
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City | BOISE
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State | ID
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Zip | 83707-0795
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Country | US
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Telephone | 208-505-1179
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAWN SCHOTT
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Credential |
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Telephone | 208-505-1179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number |
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License Number State |
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