Provider Demographics
NPI:1013208388
Name:BRADISH, LINDA JOY (LPN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JOY
Last Name:BRADISH
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:PO.BOX 184
Mailing Address - Street 2:142 S.RICH ST.
Mailing Address - City:MT. GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338
Mailing Address - Country:US
Mailing Address - Phone:740-262-9540
Mailing Address - Fax:
Practice Address - Street 1:142 S RICH ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1438
Practice Address - Country:US
Practice Address - Phone:740-262-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH110564164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse