Provider Demographics
NPI:1649279266
Name:ANDREW, BRIDGET CORNELL (PA,MPH)
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:CORNELL
Last Name:ANDREW
Suffix:
Gender:F
Credentials:PA,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 ALTO ST
Mailing Address - Street 2:LA FAMILIA MEDICAL CENTER
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2406
Mailing Address - Country:US
Mailing Address - Phone:505-982-4425
Mailing Address - Fax:505-982-6280
Practice Address - Street 1:1035 ALTO ST
Practice Address - Street 2:LA FAMILIA MEDICAL CENTER
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2406
Practice Address - Country:US
Practice Address - Phone:505-982-4425
Practice Address - Fax:505-982-6280
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2009-043363AM0700X
CO2822363AM0700X
MT566363AM0700X
NY005692-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ4167Medicaid
NMNMAAA1112Medicare PIN
P36181Medicare UPIN
NMZ4167Medicaid