Provider Demographics
NPI:1427359066
Name:BRIDGE, CARON MAXINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CARON
Middle Name:MAXINE
Last Name:BRIDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 ADEE AVE
Mailing Address - Street 2:1ST FL.
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6802
Mailing Address - Country:US
Mailing Address - Phone:917-680-8732
Mailing Address - Fax:
Practice Address - Street 1:665 ADEE AVE
Practice Address - Street 2:1ST FL.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6802
Practice Address - Country:US
Practice Address - Phone:917-680-8732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628944-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse