Provider Demographics
NPI:1659823342
Name:BRIDGFORD NURSE ANESTHESIA SERVICES
Entity Type:Organization
Organization Name:BRIDGFORD NURSE ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRIDGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:630-414-3108
Mailing Address - Street 1:1130 S MICHIGAN AVE
Mailing Address - Street 2:#3709
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2521
Mailing Address - Country:US
Mailing Address - Phone:630-414-3108
Mailing Address - Fax:630-225-5207
Practice Address - Street 1:1130 S MICHIGAN AVE
Practice Address - Street 2:#3709
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2521
Practice Address - Country:US
Practice Address - Phone:630-414-3108
Practice Address - Fax:630-225-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL79515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty