Provider Demographics
NPI:1912556192
Name:MCCALL, BRIDGETTE (RN)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:MCCALL
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 1:4432 S VENETO
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-5218
Mailing Address - Country:US
Mailing Address - Phone:480-444-8362
Mailing Address - Fax:
Practice Address - Street 1:8687 E VIA DE VENTURA STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3351
Practice Address - Country:US
Practice Address - Phone:480-609-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ202063163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse