1851048284 NPI number — BRIDGET JABLONSKI RN

Table of content: BRIDGET JABLONSKI RN (NPI 1851048284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851048284 NPI number — BRIDGET JABLONSKI RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JABLONSKI
Provider First Name:
BRIDGET
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851048284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29455 N. CAVE CREEK RD. STE 118 # 470
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAVE CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-877-0037
Provider Business Mailing Address Fax Number:
855-930-1406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6020 E CALLE DE POMPAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAVE CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85331-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-877-0037
Provider Business Practice Location Address Fax Number:
855-930-1406
Provider Enumeration Date:
03/05/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN104191 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)