Provider Demographics
NPI:1821220906
Name:ZANZUCCHI, BRIDGET DESIREE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:DESIREE
Last Name:ZANZUCCHI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:BRIDGET
Other - Middle Name:DESIREE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6314 31ST ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-7303
Mailing Address - Country:US
Mailing Address - Phone:262-605-1282
Mailing Address - Fax:
Practice Address - Street 1:6314 31ST ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-7303
Practice Address - Country:US
Practice Address - Phone:262-605-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI125535-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38330400Medicaid