Provider Demographics
NPI:1295210748
Name:ROSS, BRIDGETTE J
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:J
Last Name:ROSS
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 1:12311 THRAVES AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-4307
Mailing Address - Country:US
Mailing Address - Phone:216-688-6305
Mailing Address - Fax:
Practice Address - Street 1:12311 THRAVES AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-4307
Practice Address - Country:US
Practice Address - Phone:216-688-6305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide