Provider Demographics
NPI:1871231332
Name:BRIDER, CONNIE S (RN, APRN,ACM-RN)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:BRIDER
Suffix:
Gender:F
Credentials:RN, APRN,ACM-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-7031
Mailing Address - Country:US
Mailing Address - Phone:504-858-3731
Mailing Address - Fax:
Practice Address - Street 1:344 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-7031
Practice Address - Country:US
Practice Address - Phone:504-858-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02379163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management