MEDICARE: MARY L. BRIDDELL NP

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	363L00000X	Nurse Practitioner	201740	NC

General Provider Information

NPI Number	:	1861471419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY L. BRIDDELL NP

Provider Business Mailing Address
First Line	:	2000 FRONTIS PLAZA BLVD STE 200
Second Line	:	ATTN FORSYTH MEDICAL GROUP
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5616
Country	:	US
Telephone Number	:	336-277-2436
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 OLD LEXINGTON RD
Second Line	:	SPINE CENTER OF TMC
City	:	THOMASVILLE
State	:	NC
Zip	:	27360-3428
Country	:	US
Telephone Number	:	336-475-0200
Fax Number	:

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	07/08/2007

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