Provider Demographics
NPI:1376901405
Name:BRADSHAW, MEGAN
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MAXFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:901 GONDOLA RUN
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-7253
Mailing Address - Country:US
Mailing Address - Phone:317-695-2456
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORIAL SQUARE
Practice Address - Street 2:SUITE 305
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2835
Practice Address - Country:US
Practice Address - Phone:317-468-6274
Practice Address - Fax:317-468-6275
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28164116A163W00000X
IN71006557A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse