Provider Demographics
NPI:1417260829
Name:BAINBRIDGE, HEATHER A (RD, CDN,LDN)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:A
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:RD, CDN,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 YALE DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2848
Mailing Address - Country:US
Mailing Address - Phone:267-994-7046
Mailing Address - Fax:
Practice Address - Street 1:1299 YALE DR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-2848
Practice Address - Country:US
Practice Address - Phone:267-994-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007035133V00000X
PADN005543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered