Provider Demographics
NPI:1477151272
Name:BRADFORD, YOLANDA K (FNP-C)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:K
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:K
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4278
Mailing Address - Country:US
Mailing Address - Phone:708-486-2700
Mailing Address - Fax:708-468-2702
Practice Address - Street 1:101 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4278
Practice Address - Country:US
Practice Address - Phone:708-486-2700
Practice Address - Fax:708-468-2702
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF12200431363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner