Provider Demographics
NPI:1598826687
Name:EASTMAN, BRIDGET MONICA
Entity Type:Individual
Prefix:PROF
First Name:BRIDGET
Middle Name:MONICA
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 BERTA CANYON CT
Mailing Address - Street 2:
Mailing Address - City:PRUNEDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93907-1338
Mailing Address - Country:US
Mailing Address - Phone:831-663-5230
Mailing Address - Fax:
Practice Address - Street 1:8640 BERTA CANYON CT
Practice Address - Street 2:
Practice Address - City:PRUNEDALE
Practice Address - State:CA
Practice Address - Zip Code:93907-1338
Practice Address - Country:US
Practice Address - Phone:831-663-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP25497Medicare UPIN