Provider Demographics
NPI:1083581003
Name:BIDEGAIN, ANNA SUE (RN)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:SUE
Last Name:BIDEGAIN
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 1:3403 TIMBER MILL DR
Mailing Address - Street 2:
Mailing Address - City:STALLINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-1156
Mailing Address - Country:US
Mailing Address - Phone:704-512-1136
Mailing Address - Fax:
Practice Address - Street 1:3129 SPRINGBANK LN STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3379
Practice Address - Country:US
Practice Address - Phone:704-384-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC342500163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics