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NPI Code Detail

MEDICARE: MARY L BRIDGE CFNP

MEDICARE: MARY L BRIDGE CFNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerCOA. NP-05110OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134234263
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY L BRIDGE CFNP
Provider Business Mailing Address
First Line : 2415 AUBURN AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-2701
Country : US
Telephone Number : 513-221-4949
Fax Number : 513-241-4191
Provider Business Practice Location Address
First Line : 2415 AUBURN AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-2701
Country : US
Telephone Number : 513-241-4949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 09/28/2011

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