Provider Demographics
NPI:1134588171
Name:HOEFLICH, BRIDGET
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:HOEFLICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29325 MICKLEY RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43014-9725
Mailing Address - Country:US
Mailing Address - Phone:740-392-4211
Mailing Address - Fax:740-392-4209
Practice Address - Street 1:29325 MICKLEY RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43014-9725
Practice Address - Country:US
Practice Address - Phone:740-504-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN109678-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse