Provider Demographics
NPI:1952912198
Name:DIVERS, BRIDGET MICHELLE
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MICHELLE
Last Name:DIVERS
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:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:WV
Mailing Address - Zip Code:25241-0252
Mailing Address - Country:US
Mailing Address - Phone:304-593-3947
Mailing Address - Fax:
Practice Address - Street 1:2214 EVANSVIEW RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:WV
Practice Address - Zip Code:25241-8120
Practice Address - Country:US
Practice Address - Phone:304-593-3947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant