Provider Demographics
NPI:1922447481
Name:BRIDGES, CLARICE ILEAN ((RN-241415), MSN, (P)
Entity Type:Individual
Prefix:MRS
First Name:CLARICE
Middle Name:ILEAN
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:(RN-241415), MSN, (P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001-A EAST PARKWAY SUITE 250
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823
Mailing Address - Country:US
Mailing Address - Phone:916-876-8852
Mailing Address - Fax:916-391-0762
Practice Address - Street 1:4600 BROADWAY - SUITE 1300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820
Practice Address - Country:US
Practice Address - Phone:916-874-9823
Practice Address - Fax:916-874-9442
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA241415(RN)163W00000X
CA83883(PHN)163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health