Organization · NPI-2

Bridgewell LLC

Nurse Practitioner, Primary Care · Bolingbrook, IL

NPI number1972296382
StatusActive
Last updated in NPPESSep 1, 2023

Details

NPI
1972296382
Entity type
Organization (NPI-2)
Legal business name
Bridgewell LLC
Organization subpart
No
Enumeration date
May 31, 2023
Certification date
Sep 1, 2023
Last updated
Sep 1, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP2300X Nurse Practitioner, Primary Care––Yes
261QP2300X Clinic/Center, Primary Care––
261QC1500X Clinic/Center, Community Health––

Practice location

402 W Boughton Rd Ste A
Bolingbrook, IL 60440-1998

Phone 312-451-6148

Mailing address

402 W Boughton Rd Ste A
Bolingbrook, IL 60440-1998

Phone 312-451-6148

Authorized official

Isoken Ogbomo
Nurse Practitioner
3124516418

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