Provider Demographics
NPI:1972905586
Name:BEAUDOIN, BRIDGET ROSE (CRNA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ROSE
Last Name:BEAUDOIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:ROSE
Other - Last Name:MCGRAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6766 DANDISON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2814
Mailing Address - Country:US
Mailing Address - Phone:734-355-3230
Mailing Address - Fax:
Practice Address - Street 1:28050 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5919
Practice Address - Country:US
Practice Address - Phone:248-471-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704271499367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered