Marian Anne Bridenstine, RN, FNP
Individual provider Active NPI Nurse Practitioner · Centerville, UT
NPI 1043836679 · NPPES record last updated Oct 3, 2025
Key facts
- NPI
- 1043836679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 14214374-4405 (UT)
- Practice address
- 1222 W Legacy Crossing Blvd Ste 200
Centerville, UT 84014-5560 - Phone
- (801) 298-3802
- Fax
- (801) 298-8371
- NPI assigned
- Jun 19, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Integrated Dermatology of Bountiful LLC
Practice addresses (Care Compare)
1222 W Legacy Crossing Blvd
Suite 200
Centerville, UT 84014-5560
Phone (801) 298-3802
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251020002839 | UT | Practitioner - Nurse Practitioner | 3173997541 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0001259398 | VA | MD | Registered Nurse |
| 14214374-4405 | UT | MD | Nurse Practitioner |
| 0024179343 | VA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrated Dermatology of Bountiful LLC | Current |
Accepting new patients |
Locations
1222 W Legacy Crossing Blvd
Ste 200
Centerville, UT 84014
Phone (801) 298-3802
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 14214374-4405 | UT | Yes |
| Registered Nurse | 163W00000X | 0001259398 | VA | |
| Nurse Practitioner | 363L00000X | 0024179343 | VA |
Addresses
Primary practice location
1222 W Legacy Crossing Blvd Ste 200
Centerville, UT 84014-5560
Mailing address
1222 W Legacy Crossing Blvd Ste 200
Centerville, UT 84014-5560
Phone (801) 298-3802
Other providers in Centerville, UT
- Alyson McKean Bown
- Brad Huffaker DDS PC
- Brandon Segura
- Brave Transformations Therapy
- Brian D Rigby DMD PC
- Kevin Dee Broderick
- Melanie Brown
- Victoria Schild Brown
- Hope Nicole Burgess
- Tracy Burnham
All providers in Centerville, UT · Nurse Practitioner in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.