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General NPI Number Information
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NPI Number | 1679366298
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Entity Type | Organization
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Legal Business Name | BRIDGECARE PROVIDER GROUP MA, PLLC
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 57 OLD ROAD TO 9 ACRE COR
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City | CONCORD
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State | MA
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Zip | 01742-3317
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Country | US
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Telephone | 551-337-3278
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Fax |
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Provider Business Mailing Address
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Address Line | 57 OLD ROAD TO 9 ACRE COR
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City | CONCORD
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State | MA
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Zip | 01742-3317
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Country | US
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Telephone | 551-337-3278
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATION
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Name | MARIVIC VANOVER (JED) VANOVER
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Credential | NURSE PRACTITIONER
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Telephone | 856-448-3533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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