Provider Demographics
NPI:1982885356
Name:VIENS, BRIDGET M (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:VIENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:M
Other - Last Name:BETTENCOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-740-4478
Mailing Address - Fax:603-431-9945
Practice Address - Street 1:67 CORPORATE DRIVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2847
Practice Address - Country:US
Practice Address - Phone:603-610-8050
Practice Address - Fax:603-431-9945
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3092097Medicaid
NHRAILROAD P01096109Medicare PIN
NHAP071601Medicare PIN
NHS75164Medicare UPIN