Provider Demographics
NPI:1699549717
Name:SLAGLE, BRIDGETTE RENEE
Entity type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:RENEE
Last Name:SLAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16544 BLOOMROSE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-9422
Mailing Address - Country:US
Mailing Address - Phone:513-803-0038
Mailing Address - Fax:
Practice Address - Street 1:16544 BLOOMROSE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-9422
Practice Address - Country:US
Practice Address - Phone:513-803-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400434821204376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide