Provider Demographics
NPI:1417093097
Name:BRADFORD, CHRISTINA M (CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1740 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5667
Practice Address - Country:US
Practice Address - Phone:570-459-2901
Practice Address - Fax:570-459-6090
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009326363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA541284OtherCOVENTRY
PA50068145OtherCAPITAL BLUE CROSS
PABR1948359OtherHIGHMARK BLUE SHIELD
PA1018302700001Medicaid
PABR1948359Medicare PIN
PA0830200001Medicare NSC