Provider Demographics
NPI:1619512779
Name:BRIDGEFORD, YVONNE MARIE
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARIE
Last Name:BRIDGEFORD
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 1:2113 MASON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8903
Mailing Address - Country:US
Mailing Address - Phone:614-352-4624
Mailing Address - Fax:
Practice Address - Street 1:1 HURLEY PLZ # 4N
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-262-9284
Practice Address - Fax:810-262-9610
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty