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General NPI Number Information
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NPI Number | 1154610772
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Entity Type | Organization
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Legal Business Name | BRIDAN HEALTHCARE, LLC
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 64 BENTWOOD DR
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City | WESTAMPTON
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State | NJ
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Zip | 08060-5640
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Country | US
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Telephone | 609-410-7942
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Fax | 609-871-4002
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Provider Business Mailing Address
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Address Line | 64 BENTWOOD DR
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City | WESTAMPTON
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State | NJ
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Zip | 08060-5640
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Country | US
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Telephone | 609-410-7942
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Fax | 609-871-4002
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. VALERIE DAWN FULTON
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Credential | APN/CRNP
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Telephone | 609-410-7942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | SP010784
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 26NN10281700
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License Number State | NJ
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