Provider Demographics
NPI:1871848101
Name:BRIDGES, BETTY C (RN)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:C
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12602 REED ROCK RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-5809
Mailing Address - Country:US
Mailing Address - Phone:804-561-4516
Mailing Address - Fax:
Practice Address - Street 1:12602 REED ROCK RD
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-5809
Practice Address - Country:US
Practice Address - Phone:804-561-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001070479163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse