Healthcare Provider Details

I. General information

NPI: 1841809332
Provider Name (Legal Business Name): BRIDGET BRIDGET MACKENZIE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIDGET BRIDGET BARRETT WHNP-BC

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DEAN CIR
ANDOVER MA
01810-3304
US

IV. Provider business mailing address

5 DEAN CIR
ANDOVER MA
01810-3304
US

V. Phone/Fax

Practice location:
  • Phone: 339-223-9678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN2279377
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: