Provider Demographics
NPI:1588683213
Name:RADCLIFFE, BRONWYN KATHLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:BRONWYN
Middle Name:KATHLEEN
Last Name:RADCLIFFE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BRONWEN
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:355 COUNTY ROAD 503
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9305
Mailing Address - Country:US
Mailing Address - Phone:970-238-0438
Mailing Address - Fax:
Practice Address - Street 1:355 COUNTY ROAD 503
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-9305
Practice Address - Country:US
Practice Address - Phone:970-238-0438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01758363LF0000X
VA0024164985363LF0000X
CO100066-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04105061Medicaid
CO82-4428406OtherI DO NOT TAKE INSURANCE
COCOA106458OtherMEDICARE PTAN