Provider Demographics
NPI:1952848400
Name:WILLIS-TOWNSELL, BRIDGITTE
Entity Type:Individual
Prefix:
First Name:BRIDGITTE
Middle Name:
Last Name:WILLIS-TOWNSELL
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 1:3109 RESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-5852
Mailing Address - Country:US
Mailing Address - Phone:757-256-9504
Mailing Address - Fax:
Practice Address - Street 1:3109 RESERVE WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-5852
Practice Address - Country:US
Practice Address - Phone:757-256-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001231373163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator