Provider Demographics
NPI:1437513637
Name:BURDYSHAW, BRIDGETTE
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:
Last Name:BURDYSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 E 60TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-1926
Mailing Address - Country:US
Mailing Address - Phone:253-232-5807
Mailing Address - Fax:
Practice Address - Street 1:438 E 60TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-1926
Practice Address - Country:US
Practice Address - Phone:253-232-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist