Provider Demographics
NPI:1033551890
Name:BRIDGER, DONNA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:BRIDGER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7963
Mailing Address - Country:US
Mailing Address - Phone:803-951-5871
Mailing Address - Fax:803-951-5882
Practice Address - Street 1:2480 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7963
Practice Address - Country:US
Practice Address - Phone:803-951-5871
Practice Address - Fax:803-951-5882
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170752363LF0000X
SCAPN18697363LF0000X
WV45951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2718Medicaid
SCSC28691879Medicare UPIN
SCNP2718Medicaid