Provider Demographics
NPI:1578645511
Name:MORAN, BRIDGET GRACE (RNC, MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:GRACE
Last Name:MORAN
Suffix:
Gender:F
Credentials:RNC, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6558 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1660
Mailing Address - Country:US
Mailing Address - Phone:510-233-5285
Mailing Address - Fax:
Practice Address - Street 1:901NEVIN AVE
Practice Address - Street 2:BUILDING C, 2ND FLOOR
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801
Practice Address - Country:US
Practice Address - Phone:510-307-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244886163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory