Provider Demographics
NPI:1043836679
Name:BRIDENSTINE, MARIAN ANNE (RN, FNP)
Entity type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:ANNE
Last Name:BRIDENSTINE
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 W LEGACY CROSSING BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-5560
Mailing Address - Country:US
Mailing Address - Phone:801-298-3802
Mailing Address - Fax:801-298-8371
Practice Address - Street 1:1222 W LEGACY CROSSING BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-5560
Practice Address - Country:US
Practice Address - Phone:801-298-3802
Practice Address - Fax:801-298-8371
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14214374-4405363L00000X
VA0001259398163W00000X
VA0024179343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse