Provider Demographics
NPI:1811262694
Name:BRIDEGROOM, ANNE MARIE (PA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:BRIDEGROOM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:ZEILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5023 W 120TH AVE STE 312
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5606
Mailing Address - Country:US
Mailing Address - Phone:720-644-9355
Mailing Address - Fax:
Practice Address - Street 1:261 DUNN RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-7928
Practice Address - Country:US
Practice Address - Phone:314-830-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021004987363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1392PAMedicaid
SCAA87435453Medicare PIN