Provider Demographics
NPI:1124719729
Name:WARNECKE, BRIDGET MARIE (RT(R))
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:WARNECKE
Suffix:
Gender:F
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11028 WOODHAVEN CT N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3031
Mailing Address - Country:US
Mailing Address - Phone:161-234-6462
Mailing Address - Fax:
Practice Address - Street 1:11028 WOODHAVEN CT N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3031
Practice Address - Country:US
Practice Address - Phone:161-234-6462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist