Provider Demographics
NPI:1295084341
Name:COSTIGAN, BRIDGET M (FNP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:COSTIGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 S 11TH ST
Mailing Address - Street 2:GERALD L. IGNACE INDIAN HEALTH CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3310
Mailing Address - Country:US
Mailing Address - Phone:414-383-9526
Mailing Address - Fax:414-649-2711
Practice Address - Street 1:1711 S 11TH ST
Practice Address - Street 2:GERALD L. IGNACE INDIAN HEALTH CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3310
Practice Address - Country:US
Practice Address - Phone:414-383-9526
Practice Address - Fax:414-649-2711
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4950 33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily