Provider Demographics
NPI:1477333003
Name:BRADSHAW, LINDA DISIRE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DISIRE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46616-2149
Mailing Address - Country:US
Mailing Address - Phone:574-904-8406
Mailing Address - Fax:
Practice Address - Street 1:2213 PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46616-2149
Practice Address - Country:US
Practice Address - Phone:574-904-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health