Basic Information
| Provider Information | |||||||||
| NPI: | 1639636905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAREHAM | ||||||||
| FirstName: | BRIDGET | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9790 RHONE ST | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930043078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055853086 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2705 LOMA VISTA RD STE 205 | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930031582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055853086 | ||||||||
| FaxNumber: | 8056530616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2019 | ||||||||
| LastUpdateDate: | 02/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95010941 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 95010941 | 01 | CA | CALIFORNIA BOARD OF REGISTERED NURSING FAMILY NURSE PRACTITIONER | OTHER | 484665 | 01 | CA | CALIFORNIA BOARD OF REGISTERED NURSING, REGISTERED NURSE | OTHER | 95010941 | 01 | CA | CALIFORNIA BOARD OF REGISTERED NURSING, NURSE PRACTITIONER FURNISHING | OTHER | F10181558 | 01 | AMERICAN ASSOCIATION OF NURSE PRACTITIONERS | OTHER |