Provider Demographics
NPI:1346675634
Name:GIAMPA, BRIDGET BARRESI
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:BARRESI
Last Name:GIAMPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:BARRESI
Other - Last Name:GIAMPA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:812 S LONG LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3651
Mailing Address - Country:US
Mailing Address - Phone:248-343-4490
Mailing Address - Fax:
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704269909363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health