Provider Demographics
NPI:1073523874
Name:CIANCHETTI-BRIDGEFORD, JULIE A (CNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:CIANCHETTI-BRIDGEFORD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-6078
Mailing Address - Country:US
Mailing Address - Phone:513-454-1460
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:903 NW WASHINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6367
Practice Address - Country:US
Practice Address - Phone:513-454-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06470207V00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2318503Medicaid
OH2040759Medicaid
OH2103600Medicaid
OH2108221Medicaid
OH1063482OtherWORKERS COMP NUMBER
OH1063482OtherWORKERS COMP NUMBER
OH2040759Medicaid