Individual
STACEY BRIDGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 RAINBOW DR UNIT 35, PINEVILLE, LA 71360-6979
(318) 487-5191
Mailing address
3319 MARYE ST, ALEXANDRIA, LA 71301-4820
(318) 443-4587
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
260018
LA
Other
Enumeration date
08/22/2006
Last updated
07/08/2007
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