Provider Demographics
NPI:1649778549
Name:BRADLEY, TRUDY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:ANN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-1213
Mailing Address - Country:US
Mailing Address - Phone:717-202-5426
Mailing Address - Fax:
Practice Address - Street 1:322 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067-1213
Practice Address - Country:US
Practice Address - Phone:717-202-5426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN277163164W00000X
PAPNW00000X164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse