Provider Demographics
NPI:1861937310
Name:RENDA, BRIDGET (NP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:RENDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 GOODWILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8709
Mailing Address - Country:US
Mailing Address - Phone:315-219-1951
Mailing Address - Fax:
Practice Address - Street 1:2300 HIGHWAY 150
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310
Practice Address - Country:US
Practice Address - Phone:336-644-6384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily