Provider Demographics
NPI:1669838892
Name:BRADLEY, MAUREEN (RN, PHN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9327 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2729
Mailing Address - Country:US
Mailing Address - Phone:562-464-5380
Mailing Address - Fax:562-693-4525
Practice Address - Street 1:7643 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2358
Practice Address - Country:US
Practice Address - Phone:917-373-5571
Practice Address - Fax:562-693-4525
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA802944163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management