Provider Demographics
NPI:1164172144
Name:BRADLEY, SHAWNA R (DNP)
Entity Type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:R
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:WISHEK
Mailing Address - State:ND
Mailing Address - Zip Code:58495-7527
Mailing Address - Country:US
Mailing Address - Phone:701-452-2326
Mailing Address - Fax:
Practice Address - Street 1:1007 4TH AVE S
Practice Address - Street 2:
Practice Address - City:WISHEK
Practice Address - State:ND
Practice Address - Zip Code:58495-7527
Practice Address - Country:US
Practice Address - Phone:701-452-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR43239163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse