Provider Demographics
NPI:1811948821
Name:PETERSON, BRIDGET S (CRNFA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:S
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5691 HOUSEMAN RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-9709
Mailing Address - Country:US
Mailing Address - Phone:719-676-7060
Mailing Address - Fax:719-676-7808
Practice Address - Street 1:5691 HOUSEMAN RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-9709
Practice Address - Country:US
Practice Address - Phone:719-676-7060
Practice Address - Fax:719-676-7808
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78853163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse