Provider Demographics
NPI:1104390814
Name:WARD, STEVEN BRADFORD (RN)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRADFORD
Last Name:WARD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:SESSER
Mailing Address - State:IL
Mailing Address - Zip Code:62884-1601
Mailing Address - Country:US
Mailing Address - Phone:314-494-1237
Mailing Address - Fax:
Practice Address - Street 1:7212 BALSON AVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-3001
Practice Address - Country:US
Practice Address - Phone:314-726-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007007081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse