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General NPI Number Information
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NPI Number | 1902949464
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Entity Type | Individual
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Provider Name | DEBRA L BRIDGE
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 280 EXEMPLA CIR
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City | LAFAYETTE
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State | CO
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Zip | 80026-3370
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Country | US
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Telephone | 303-861-3506
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 BLACK DUCK AVE
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City | JOHNSTOWN
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State | CO
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Zip | 80534-9270
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Country | US
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Telephone | 970-587-0775
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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 | 163WX0200X
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Taxonomy Name | Oncology Registered Nurse
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License Number | 90888
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License Number State | CO
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