Provider Demographics
NPI:1497406805
Name:ACKEIFI, BRIDGITTE F
Entity Type:Individual
Prefix:
First Name:BRIDGITTE
Middle Name:F
Last Name:ACKEIFI
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 1:22 CASE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2215
Mailing Address - Country:US
Mailing Address - Phone:860-823-1399
Mailing Address - Fax:860-823-1170
Practice Address - Street 1:41 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3633
Practice Address - Country:US
Practice Address - Phone:860-399-1399
Practice Address - Fax:860-823-1170
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10374363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health