Provider Demographics
NPI:1730916149
Name:MOLLOY, BRIDGET ELIZABETH (LPN)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ELIZABETH
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 FOOTHILLS PLZ
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-2305
Mailing Address - Country:US
Mailing Address - Phone:516-359-3360
Mailing Address - Fax:
Practice Address - Street 1:576 FOOTHILLS PLZ
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-2305
Practice Address - Country:US
Practice Address - Phone:516-359-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323377164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse