Provider Demographics
NPI:1508166828
Name:CARNAHAN, BRIDGET RUSSELL (DO)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:RUSSELL
Last Name:CARNAHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6470 NE MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1617
Mailing Address - Country:US
Mailing Address - Phone:360-953-2424
Mailing Address - Fax:
Practice Address - Street 1:159 WYATT WAY NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1878
Practice Address - Country:US
Practice Address - Phone:206-596-0974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO1971652084P0800X, 202D00000X
WAOP61012353202D00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine