Provider Demographics
NPI:1699245415
Name:BIDWELL, SUSAN NININGER (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:NININGER
Last Name:BIDWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 BALMORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-5640
Mailing Address - Country:US
Mailing Address - Phone:615-896-1854
Mailing Address - Fax:
Practice Address - Street 1:2208 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-5800
Practice Address - Country:US
Practice Address - Phone:615-890-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000080712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse