Provider Demographics
NPI:1689646218
Name:GOURLEY, BRIDGITTE C (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGITTE
Middle Name:C
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:BRIDGITTE
Other - Middle Name:C
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1419 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1482
Mailing Address - Country:US
Mailing Address - Phone:410-990-0050
Mailing Address - Fax:410-990-0336
Practice Address - Street 1:1419 FOREST DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1482
Practice Address - Country:US
Practice Address - Phone:410-990-0050
Practice Address - Fax:410-990-0336
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR139679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD839600100Medicaid
MD279195Y5ZMedicare PIN
279195YT9AMedicare PIN