Provider Demographics
NPI:1265868236
Name:BRIDGMAN, LAURA DIANE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DIANE
Last Name:BRIDGMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:216 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2558
Mailing Address - Country:US
Mailing Address - Phone:740-432-3434
Mailing Address - Fax:740-432-3053
Practice Address - Street 1:216 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2558
Practice Address - Country:US
Practice Address - Phone:740-432-3434
Practice Address - Fax:740-432-3053
Is Sole Proprietor?:No
Enumeration Date:2013-09-22
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant