Provider Demographics
NPI:1649899253
Name:JENNISON, BRIDGET MULVIHILL (RN)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MULVIHILL
Last Name:JENNISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GEORGE MASON UNIVERSITY, 4400 UNIVERSITY DRIVE,
Mailing Address - Street 2:SCHOOL OF NURSING, MAP CLINIC COORDINATOR
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-618-4249
Mailing Address - Fax:
Practice Address - Street 1:99 TREMONT STREET
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-2011
Practice Address - Country:US
Practice Address - Phone:703-618-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001201367163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health