Provider Demographics
NPI:1225009996
Name:BRADLEY, ESTENA PATRICIA (NP- WOMENS HEALTH)
Entity Type:Individual
Prefix:
First Name:ESTENA
Middle Name:PATRICIA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:NP- WOMENS HEALTH
Other - Prefix:
Other - First Name:ESTENA
Other - Middle Name:B
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNCGONP
Mailing Address - Street 1:PO BOX 1541
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-1541
Mailing Address - Country:US
Mailing Address - Phone:252-492-8576
Mailing Address - Fax:252-492-7464
Practice Address - Street 1:1209 SE INDUSTRY DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565
Practice Address - Country:US
Practice Address - Phone:252-492-8576
Practice Address - Fax:252-492-7464
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79052363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC500018286OtherRR MEDICARE
S55561Medicare UPIN
NC500018286OtherRR MEDICARE