Provider Demographics
NPI:1033709639
Name:WILLIAMS, BRIDGETT
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 S WAPAK RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-4315
Mailing Address - Country:US
Mailing Address - Phone:419-303-1031
Mailing Address - Fax:
Practice Address - Street 1:1711 LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3137
Practice Address - Country:US
Practice Address - Phone:419-204-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide