Provider Demographics
NPI:1780741215
Name:BRIDGWATER, DONNA (LSA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:BRIDGWATER
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:AGRELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSA
Mailing Address - Street 1:7324 SOUTHWEST FWY STE 1550
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2053
Mailing Address - Country:US
Mailing Address - Phone:832-804-8716
Mailing Address - Fax:832-804-8816
Practice Address - Street 1:7324 SOUTHWEST FWY STE 1550
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2053
Practice Address - Country:US
Practice Address - Phone:832-804-8716
Practice Address - Fax:832-804-8816
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00166246ZC0007X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant