Provider Demographics
NPI:1689720963
Name:BRIDGENS, NANCY KIESER (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:KIESER
Last Name:BRIDGENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 W RIDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1415
Mailing Address - Country:US
Mailing Address - Phone:610-495-0400
Mailing Address - Fax:
Practice Address - Street 1:100 MARKET ST STE 300
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-4927
Practice Address - Country:US
Practice Address - Phone:484-622-7940
Practice Address - Fax:484-622-7950
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOSOO4589L207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37148Medicare UPIN