Provider Demographics
NPI:1366327355
Name:STORM, BRIDGET (MA, RD-AP, LDN, CNSC)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:STORM
Suffix:
Gender:F
Credentials:MA, RD-AP, LDN, CNSC
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:GARVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, RD, LDN, CNSC
Mailing Address - Street 1:1709 N BROOM ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3011
Mailing Address - Country:US
Mailing Address - Phone:610-331-2476
Mailing Address - Fax:
Practice Address - Street 1:1709 N BROOM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3011
Practice Address - Country:US
Practice Address - Phone:610-331-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0000286133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered