Provider Demographics
NPI:1538825245
Name:MCILVAIN, BRIDGET (CRNA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MCILVAIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W GERMANTOWN PIKE STE 150
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1062
Mailing Address - Country:US
Mailing Address - Phone:610-525-4966
Mailing Address - Fax:610-525-0874
Practice Address - Street 1:3 CRESCENT DR STE 310
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1017
Practice Address - Country:US
Practice Address - Phone:267-419-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN688178367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered