Provider Demographics
NPI:1386845246
Name:SILVELA-BACALING, BRIDGID (NP)
Entity Type:Individual
Prefix:
First Name:BRIDGID
Middle Name:
Last Name:SILVELA-BACALING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39302 N QUEENSBURY LN
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60083-3018
Mailing Address - Country:US
Mailing Address - Phone:847-263-9110
Mailing Address - Fax:
Practice Address - Street 1:2615 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4980
Practice Address - Country:US
Practice Address - Phone:847-360-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR03631Medicare PIN
ILR03630Medicare PIN