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General NPI Number Information
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NPI Number | 1205461498
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Entity Type | Individual
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Provider Name | JENNIFER LYNN BRESEMAN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/08/2020
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 44084 RIVERSIDE PARKWAY, SUITE 300
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City | LEESBURG
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State | VA
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Zip | 20176-5102
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Country | US
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Telephone | 703-724-7530
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Fax | 703-858-2870
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Provider Business Mailing Address
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Address Line | 224-D CORNWALL STREET, NW, SUITE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 703-443-8643
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024181430
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 0001150606
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License Number State | VA
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