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General NPI Number Information
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NPI Number | 1295285278
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Entity Type | Individual
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Provider Name | BRIDGET SHEA-GANDER
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Gender | Female
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 29 ELM ST
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City | SOUTH DEERFIELD
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State | MA
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Zip | 01373-1005
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Country | US
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Telephone | 413-665-9111
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Fax |
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Provider Business Mailing Address
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Address Line | 19 RIVER RD S
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City | PUTNEY
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State | VT
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Zip | 05346-8517
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | CNP-03085
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 101.0134628
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN2372845
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License Number State | MA
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