Provider Demographics
NPI:1497780233
Name:HECKLER, BRIDGET E (CNM)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:E
Last Name:HECKLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-394-7313
Practice Address - Street 1:1140 S KNOXVILLE AVE STE B
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2609
Practice Address - Country:US
Practice Address - Phone:419-394-7314
Practice Address - Fax:419-394-7313
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-00663-NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9934723OtherMEDICARE GROUP PTAN
OH1447288717OtherGROUP NPI
OHH295760OtherMEDICARE INDIVIDUAL PTAN
OH2070459Medicaid
OH2821558OtherMEDICAID LEGACY