Provider Demographics
NPI:1740720895
Name:BRIDGETT SPANO
Entity type:Organization
Organization Name:BRIDGETT SPANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SPANO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:315-520-4601
Mailing Address - Street 1:6381 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6817
Mailing Address - Country:US
Mailing Address - Phone:315-520-4601
Mailing Address - Fax:
Practice Address - Street 1:6381 TRENTON RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6817
Practice Address - Country:US
Practice Address - Phone:315-520-4601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274037-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health