Provider Demographics
NPI:1821895269
Name:BRADENHAM, BRIDGET GALLAGHER (CRNP, FNP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:GALLAGHER
Last Name:BRADENHAM
Suffix:
Gender:F
Credentials:CRNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8113 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8419
Mailing Address - Country:US
Mailing Address - Phone:215-510-6638
Mailing Address - Fax:
Practice Address - Street 1:2200 ARCH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1330
Practice Address - Country:US
Practice Address - Phone:215-561-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031803363LF0000X
PARN700484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse