Provider Demographics
NPI:1972736577
Name:NEWBRIDGE CLINIC P.A.
Entity Type:Organization
Organization Name:NEWBRIDGE CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELSETH
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:612-730-2237
Mailing Address - Street 1:8200 HUMBOLDT AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1433
Mailing Address - Country:US
Mailing Address - Phone:612-730-2237
Mailing Address - Fax:206-338-2186
Practice Address - Street 1:8200 HUMBOLDT AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1433
Practice Address - Country:US
Practice Address - Phone:612-730-2237
Practice Address - Fax:206-338-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty