Provider Demographics
NPI:1467195644
Name:BRADFUTE, NAOMI ELLEN (ND PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:ELLEN
Last Name:BRADFUTE
Suffix:
Gender:F
Credentials:ND PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4506
Mailing Address - Street 2:
Mailing Address - City:SOUTH COLBY
Mailing Address - State:WA
Mailing Address - Zip Code:98384-0506
Mailing Address - Country:US
Mailing Address - Phone:530-559-9782
Mailing Address - Fax:
Practice Address - Street 1:9850 SE SOUTHWORTH DR
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-8943
Practice Address - Country:US
Practice Address - Phone:360-769-3734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61531190363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health