Provider Demographics
NPI:1679523310
Name:LEARY, BRIDGET JOSEPHINE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:JOSEPHINE
Last Name:LEARY
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1316
Mailing Address - Country:US
Mailing Address - Phone:478-960-5780
Mailing Address - Fax:
Practice Address - Street 1:654 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2851
Practice Address - Country:US
Practice Address - Phone:478-738-9443
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily