Provider Demographics
NPI:1437258589
Name:HARCUS-WICKERSHAM, BRIDGET E (DNP, APNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:E
Last Name:HARCUS-WICKERSHAM
Suffix:
Gender:F
Credentials:DNP, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:408 LAKEWOOD DR
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC.
Mailing Address - City:WILLIAMS BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53191-9507
Mailing Address - Country:US
Mailing Address - Phone:262-607-6399
Mailing Address - Fax:866-616-0686
Practice Address - Street 1:1905 E HUEBBE PKWY
Practice Address - Street 2:BELOIT HEALTH SYSTEM INC
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-2240
Practice Address - Fax:608-363-7374
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2882-033363L00000X
WI2882-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36033500Medicaid
WI2005009876OtherANCC