Provider Demographics
NPI:1578743472
Name:BRIDGFORD, CHRISTY L (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:BRIDGFORD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W JACKSON STREET
Mailing Address - Street 2:SIH MEDICAL GROUP ANESTHESIOLOGY
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901
Mailing Address - Country:US
Mailing Address - Phone:618-549-0721
Mailing Address - Fax:618-529-0449
Practice Address - Street 1:1632 S INDIANA AVE APT 409
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1374
Practice Address - Country:US
Practice Address - Phone:630-414-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011543367500000X
TX704436367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered