Provider Demographics
NPI:1467796417
Name:BRADFORD, JULIE ELLEN (MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ELLEN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:STE. 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:26908 DETROIT RD
Practice Address - Street 2:STE. 200
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2398
Practice Address - Country:US
Practice Address - Phone:440-250-8660
Practice Address - Fax:440-250-8639
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH13776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH008717Medicaid
OH008717Medicaid