Provider Demographics
NPI:1588213003
Name:BRADLEY, CHRISTINE CRYSTAL
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CRYSTAL
Last Name:BRADLEY
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 1:101 G ST SW APT A519
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-4323
Mailing Address - Country:US
Mailing Address - Phone:240-461-2987
Mailing Address - Fax:
Practice Address - Street 1:101 G. ST. SW
Practice Address - Street 2:#A519
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2002
Practice Address - Country:US
Practice Address - Phone:240-461-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide