Provider Demographics
NPI:1629734538
Name:BRADLEY, TORI (BSN,RN)
Entity Type:Individual
Prefix:MISS
First Name:TORI
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:NORRIS CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62869-0301
Mailing Address - Country:US
Mailing Address - Phone:618-384-1141
Mailing Address - Fax:
Practice Address - Street 1:328 SPENCE STREET
Practice Address - Street 2:
Practice Address - City:NORRIS CITY
Practice Address - State:IL
Practice Address - Zip Code:62869
Practice Address - Country:US
Practice Address - Phone:618-384-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL014166545163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILSCHOOLOtherSCHOOL