Provider Demographics
NPI:1669881108
Name:MOORE, BRIDGETTE ANN (RN)
Entity type:Individual
Prefix:MISS
First Name:BRIDGETTE
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:BRIDGETTE
Other - Middle Name:ANN
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 MEADOW THRUSH DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45315-8725
Mailing Address - Country:US
Mailing Address - Phone:937-248-4135
Mailing Address - Fax:
Practice Address - Street 1:1111 MEADOW THRUSH DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OH
Practice Address - Zip Code:45315-8725
Practice Address - Country:US
Practice Address - Phone:937-248-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN278494163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse