Provider Demographics
NPI:1447782008
Name:BRADLEY, DORA LEE (CNA)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:LEE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 WYNORA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-2465
Mailing Address - Country:US
Mailing Address - Phone:937-204-8173
Mailing Address - Fax:
Practice Address - Street 1:622 WYNORA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-2465
Practice Address - Country:US
Practice Address - Phone:937-204-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide