Provider Demographics
NPI:1265926174
Name:ATUD, BRIDGET ABONG
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ABONG
Last Name:ATUD
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 1:3301 CHAUNCEY PL APT 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1003
Mailing Address - Country:US
Mailing Address - Phone:240-970-3424
Mailing Address - Fax:
Practice Address - Street 1:3301 CHAUNCEY PL APT 101
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1003
Practice Address - Country:US
Practice Address - Phone:240-970-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide