Provider Demographics
NPI:1710413455
Name:SCOTT-BRIDGES, MODESTY (LPN)
Entity type:Individual
Prefix:
First Name:MODESTY
Middle Name:
Last Name:SCOTT-BRIDGES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PARKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1323
Mailing Address - Country:US
Mailing Address - Phone:585-773-7148
Mailing Address - Fax:
Practice Address - Street 1:5 PARKWOOD LN
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1323
Practice Address - Country:US
Practice Address - Phone:585-773-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326204164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse