Provider Demographics
NPI:1174210355
Name:BRIDGEFORTH, ANNISSA MARIE (RN)
Entity type:Individual
Prefix:
First Name:ANNISSA
Middle Name:MARIE
Last Name:BRIDGEFORTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-967-4324
Mailing Address - Fax:310-967-3892
Practice Address - Street 1:8631 W 3RD ST STE 810E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5958
Practice Address - Country:US
Practice Address - Phone:310-967-4324
Practice Address - Fax:310-967-3892
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95033021363LW0102X
DCRN00001519163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse