Provider Demographics
NPI:1881436905
Name:JOHNSON, BRIDGET LYNN
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-3146
Mailing Address - Country:US
Mailing Address - Phone:248-701-7719
Mailing Address - Fax:248-484-6641
Practice Address - Street 1:168 PERKINS ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-3146
Practice Address - Country:US
Practice Address - Phone:248-701-7719
Practice Address - Fax:248-484-6641
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide