Provider Demographics
NPI:1639636905
Name:WAREHAM, BRIDGET ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ELIZABETH
Last Name:WAREHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9790 RHONE ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-3078
Mailing Address - Country:US
Mailing Address - Phone:805-585-3086
Mailing Address - Fax:
Practice Address - Street 1:2705 LOMA VISTA RD STE 205
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1582
Practice Address - Country:US
Practice Address - Phone:805-585-3086
Practice Address - Fax:805-653-0616
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95010941OtherCALIFORNIA BOARD OF REGISTERED NURSING FAMILY NURSE PRACTITIONER
CA484665OtherCALIFORNIA BOARD OF REGISTERED NURSING, REGISTERED NURSE
CA95010941OtherCALIFORNIA BOARD OF REGISTERED NURSING, NURSE PRACTITIONER FURNISHING
F10181558OtherAMERICAN ASSOCIATION OF NURSE PRACTITIONERS