Provider Demographics
NPI:1578586491
Name:BRADLO, MELISSA A (WHNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:BRADLO
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-6800
Mailing Address - Fax:314-996-6805
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:STE 254C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-996-6800
Practice Address - Fax:314-996-6805
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO133637363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429358401Medicaid
MO429358401Medicaid
MO429358401Medicaid
IL$$$$$$$$$001Medicaid