Provider Demographics
NPI:1467270652
Name:GREGORY, BRIDGET CAROSELLO (RN, BSN)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:CAROSELLO
Last Name:GREGORY
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 S 216TH ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-4729
Mailing Address - Country:US
Mailing Address - Phone:402-332-3048
Mailing Address - Fax:
Practice Address - Street 1:11705 S 216TH STREET
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028
Practice Address - Country:US
Practice Address - Phone:402-332-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE96035163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool