Provider Demographics
NPI:1366930331
Name:THORNE, BRIDGET C (NP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:C
Last Name:THORNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:C
Other - Last Name:WHITFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 RONALD REAGAN PKWY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-217-3500
Practice Address - Fax:317-217-3551
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007933A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN068010607OtherMEDICARE PTAN
IN267030117OtherMEDICARE PTAN
IN000001383546OtherANTHEM PTAN
IN300013953Medicaid
INQ00006040OtherRAILROAD PTAN
IN264430743OtherMEDICARE PTAN
INP02429781OtherRAILROAD PTAN