Provider Demographics
NPI:1841554474
Name:NORTHERN BRIDGES
Entity type:Organization
Organization Name:NORTHERN BRIDGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOISSY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:715-418-3502
Mailing Address - Street 1:935 235TH ST
Mailing Address - Street 2:
Mailing Address - City:DRESSER
Mailing Address - State:WI
Mailing Address - Zip Code:54009-9073
Mailing Address - Country:US
Mailing Address - Phone:715-755-3503
Mailing Address - Fax:
Practice Address - Street 1:805 200TH ST
Practice Address - Street 2:
Practice Address - City:DRESSER
Practice Address - State:WI
Practice Address - Zip Code:54009-4509
Practice Address - Country:US
Practice Address - Phone:715-755-2480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177109-30251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health