Provider Demographics
NPI:1194382515
Name:KRAUTWURST, BRIDGET N (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:N
Last Name:KRAUTWURST
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BOILEAU CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-8002
Mailing Address - Country:US
Mailing Address - Phone:240-994-0104
Mailing Address - Fax:
Practice Address - Street 1:33 BOILEAU CT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-8002
Practice Address - Country:US
Practice Address - Phone:240-994-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185443163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant