MEDICARE: BRIDGETTE EAGLE CNA

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
1	246RP1900X	Phlebotomy Technician	B4F5N3G4	IL
2	261QH0100X	Health Service Clinic/Center		IL

General Provider Information

NPI Number	:	1154067395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETTE EAGLE CNA

Provider Business Mailing Address
First Line	:	111 N WABASH AVE STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1903
Country	:	US
Telephone Number	:	872-401-9186
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N WABASH AVE STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1903
Country	:	US
Telephone Number	:	872-401-9186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	05/06/2026

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Directions to “ BRIDGETTE EAGLE CNA” Practice Location

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