Provider Demographics
NPI:1639269707
Name:BRADFORD, CAROLYN A (CNM)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:A
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:A
Other - Last Name:NORMOYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1400 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4422
Mailing Address - Country:US
Mailing Address - Phone:209-522-1027
Mailing Address - Fax:
Practice Address - Street 1:1400 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4422
Practice Address - Country:US
Practice Address - Phone:209-522-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3174363LF0000X
CANM639367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily