Provider Demographics
NPI:1114708120
Name:BRADSHAW, AMIE (CPC)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:
Other - Last Name:MERACLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2104
Mailing Address - Country:US
Mailing Address - Phone:509-688-5738
Mailing Address - Fax:
Practice Address - Street 1:901 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2104
Practice Address - Country:US
Practice Address - Phone:509-688-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61444598175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty