Provider Demographics
NPI:1083836910
Name:BRADFORD, MARY LUCILE (NNP-BC, MN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LUCILE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:NNP-BC, MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ROWENA PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3134
Mailing Address - Country:US
Mailing Address - Phone:303-673-9959
Mailing Address - Fax:
Practice Address - Street 1:1719 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1235
Practice Address - Country:US
Practice Address - Phone:303-839-7790
Practice Address - Fax:303-839-7987
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO125034363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal