Provider Demographics
NPI:1295413102
Name:BRIDGES SEATTLE LLC
Entity type:Organization
Organization Name:BRIDGES SEATTLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RONCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-771-0536
Mailing Address - Street 1:PO BOX 110255
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0255
Mailing Address - Country:US
Mailing Address - Phone:206-745-1191
Mailing Address - Fax:888-467-5306
Practice Address - Street 1:1751 NE NAOMI PL
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6828
Practice Address - Country:US
Practice Address - Phone:206-745-1191
Practice Address - Fax:888-467-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty