Provider Demographics
NPI:1326563883
Name:WILLE, BRIDGET BETH-OBRIEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:BETH-OBRIEN
Last Name:WILLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:535 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2105
Mailing Address - Country:US
Mailing Address - Phone:248-632-9299
Mailing Address - Fax:
Practice Address - Street 1:1455 S LAPEER RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1468
Practice Address - Country:US
Practice Address - Phone:248-693-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-06
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008232363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical