Provider Demographics
NPI:1417496993
Name:GHARST, BRIDGET B (NP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:B
Last Name:GHARST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:9155 SW BARNES RD STE 536
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6785
Practice Address - Country:US
Practice Address - Phone:503-935-8100
Practice Address - Fax:503-935-8110
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR201907568NP-PP363L00000X
KS77503363L00000X
MO2017002493363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500773911Medicaid