Provider Demographics
NPI:1942904941
Name:BENNETT, BRIDGET (APRN)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1840
Mailing Address - Country:US
Mailing Address - Phone:435-896-9561
Mailing Address - Fax:435-896-9564
Practice Address - Street 1:879 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1840
Practice Address - Country:US
Practice Address - Phone:435-896-9561
Practice Address - Fax:435-896-9564
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT277299-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily