Provider Demographics
NPI:1639130388
Name:BRADWAY, CHRISTINE K (WANICH) (PHD, RN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:K (WANICH)
Last Name:BRADWAY
Suffix:
Gender:F
Credentials:PHD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LANGDALE CT
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1648
Mailing Address - Country:US
Mailing Address - Phone:215-573-3051
Mailing Address - Fax:
Practice Address - Street 1:8815 GERMANTOWN A VE
Practice Address - Street 2:SUITE 21
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118
Practice Address - Country:US
Practice Address - Phone:215-242-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP001057H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology