Provider Demographics
NPI:1780190462
Name:BESSEM, BRIDGET OJONG
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:OJONG
Last Name:BESSEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 NEW HAMPSHIRE AVE APT 1014
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6955
Mailing Address - Country:US
Mailing Address - Phone:240-704-5281
Mailing Address - Fax:
Practice Address - Street 1:7401 NEW HAMPSHIRE AVE APT 1014
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6955
Practice Address - Country:US
Practice Address - Phone:240-704-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13320374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide