Provider Demographics
NPI:1154610772
Name:BRIDAN HEALTHCARE, LLC
Entity type:Organization
Organization Name:BRIDAN HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:APN/CRNP
Authorized Official - Phone:609-410-7942
Mailing Address - Street 1:64 BENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-5640
Mailing Address - Country:US
Mailing Address - Phone:609-410-7942
Mailing Address - Fax:609-871-4002
Practice Address - Street 1:64 BENTWOOD DR
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-5640
Practice Address - Country:US
Practice Address - Phone:609-410-7942
Practice Address - Fax:609-871-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010784363LW0102X
NJ26NN10281700363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty