Provider Demographics
NPI:1578649950
Name:HALLSTROM, BRIDGETT BAIO (NP)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETT
Middle Name:BAIO
Last Name:HALLSTROM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 UPPER POND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9599
Mailing Address - Country:US
Mailing Address - Phone:847-842-1681
Mailing Address - Fax:
Practice Address - Street 1:738 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2640
Practice Address - Country:US
Practice Address - Phone:847-382-5111
Practice Address - Fax:847-382-8993
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner