Provider Demographics
NPI:1629298203
Name:HITES, BRIDGETT ANN'LOUISE
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:ANN'LOUISE
Last Name:HITES
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 1:540 W INTERNATIONAL AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1105
Mailing Address - Country:US
Mailing Address - Phone:907-561-5335
Mailing Address - Fax:
Practice Address - Street 1:603 COLONY RD
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-1230
Practice Address - Country:US
Practice Address - Phone:330-701-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2392183374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2392183OtherINDEPENDANT PROVIDER