Provider Demographics
NPI:1568472124
Name:BRADY, REBECCA LYNN (CNM RN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:BRADY
Suffix:
Gender:F
Credentials:CNM RN
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:MIDGETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM RN
Mailing Address - Street 1:21 HONEYSUCKLE ROAD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:856-374-8343
Mailing Address - Fax:
Practice Address - Street 1:317 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103
Practice Address - Country:US
Practice Address - Phone:856-365-3519
Practice Address - Fax:856-963-2185
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR10137400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse