1891052973 NPI number — MS. CYNTHIA FISH BRIDGEWATER CRNP

Table of content: MS. CYNTHIA FISH BRIDGEWATER CRNP (NPI 1891052973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891052973 NPI number — MS. CYNTHIA FISH BRIDGEWATER CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIDGEWATER
Provider First Name:
CYNTHIA
Provider Middle Name:
FISH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1891052973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
804 NARROWS POINT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-8610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-408-5682
Provider Business Mailing Address Fax Number:
205-975-9545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 4TH AVE SOUTH
Provider Second Line Business Practice Location Address:
CPP210
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-939-5282
Provider Business Practice Location Address Fax Number:
205-978-9545
Provider Enumeration Date:
04/13/2012

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: 363LP0200X , with the licence number:  1-029931 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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