Provider Demographics
NPI:1699228536
Name:LONERGAN, BRIDGET ANN (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:BRIDGET
Middle Name:ANN
Last Name:LONERGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 S J ST STE 120
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4965
Mailing Address - Country:US
Mailing Address - Phone:253-428-2200
Mailing Address - Fax:360-830-1385
Practice Address - Street 1:1812 S J ST STE 120
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4965
Practice Address - Country:US
Practice Address - Phone:253-428-2200
Practice Address - Fax:360-830-1385
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60182248163W00000X
WAAP60696109363L00000X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2070153Medicaid