Provider Demographics
NPI:1760867394
Name:BRYDEN, KATHERINE PARKER (CNM)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:PARKER
Last Name:BRYDEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:COLLEEN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 W 9TH ST # G4500
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5401
Mailing Address - Country:US
Mailing Address - Phone:319-272-8200
Mailing Address - Fax:
Practice Address - Street 1:3421 W 9TH ST STE G4500
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5401
Practice Address - Country:US
Practice Address - Phone:319-272-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB140757367A00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife