Provider Demographics
NPI:1659655777
Name:DEMOTT, BRIDGET M
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:M
Last Name:DEMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:M
Other - Last Name:DEMOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:907 POPLAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:NY
Mailing Address - Zip Code:13849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:907 POPLAR HILL RD
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:NY
Practice Address - Zip Code:13849
Practice Address - Country:US
Practice Address - Phone:607-369-3472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22526738163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse