Provider Demographics
NPI:1871613752
Name:STULL, BRIDGET MARIE (CNA GNA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:STULL
Suffix:
Gender:F
Credentials:CNA GNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CUMBERLAND VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-1203
Mailing Address - Country:US
Mailing Address - Phone:717-977-6007
Mailing Address - Fax:717-387-7053
Practice Address - Street 1:33 CUMBERLAND VALLEY AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-1203
Practice Address - Country:US
Practice Address - Phone:717-977-6007
Practice Address - Fax:717-387-7053
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00072880376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide