Provider Demographics
NPI:1508331240
Name:BRADSHAW, JOSEPH (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 S ZENOBIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-2031
Mailing Address - Country:US
Mailing Address - Phone:303-356-2938
Mailing Address - Fax:
Practice Address - Street 1:5290 W PRINCETON DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80235-3127
Practice Address - Country:US
Practice Address - Phone:303-988-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23Z784311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home