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General NPI Number Information
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NPI Number | 1811262694
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Entity Type | Individual
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Provider Name | ANNE MARIE BRIDEGROOM PA
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Gender | Female
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 261 DUNN RD
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City | FLORISSANT
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State | MO
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Zip | 63031-7928
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Country | US
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Telephone | 314-830-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 5023 W 120TH AVE STE 312
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City | BROOMFIELD
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State | CO
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Zip | 80020-5606
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Country | US
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Telephone | 720-644-9355
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2021004987
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License Number State | MO
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