Provider Demographics
NPI:1679751036
Name:STRADLEY, BERNIE LEE VI
Entity Type:Individual
Prefix:MR
First Name:BERNIE
Middle Name:LEE
Last Name:STRADLEY
Suffix:VI
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 LANDER LN
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-9401
Mailing Address - Country:US
Mailing Address - Phone:307-635-2826
Mailing Address - Fax:
Practice Address - Street 1:2303 LANDER LN
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-9401
Practice Address - Country:US
Practice Address - Phone:307-635-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor