Individual
MS. BRIDGETT ANN WEKENBORG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
404 N KEENE ST, DC608.00, COLUMBIA, MO 65201-6626
(573) 771-4265
(573) 219-4292
Mailing address
404 N KEENE ST, DC608.00, COLUMBIA, MO 65201-6626
(573) 771-4265
(573) 219-4292
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2012030997
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912258195
—
MO
Enumeration date
09/27/2012
Last updated
10/28/2016
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