Provider Demographics
NPI:1992905467
Name:GREEN, BRIDGET DAWN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:DAWN
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4210 PIONEER WOODS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7561
Mailing Address - Country:US
Mailing Address - Phone:402-488-4321
Mailing Address - Fax:402-488-4355
Practice Address - Street 1:4210 PIONEER WOODS DR
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7561
Practice Address - Country:US
Practice Address - Phone:402-488-4321
Practice Address - Fax:402-488-4355
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1334363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1334OtherNEBRASKA STATE LISENCE