Provider Demographics
NPI:1679859995
Name:BRADMON, MOLLIE M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:M
Last Name:BRADMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1175 58TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4808
Mailing Address - Country:US
Mailing Address - Phone:970-495-0300
Mailing Address - Fax:970-224-9624
Practice Address - Street 1:1175 58TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4808
Practice Address - Country:US
Practice Address - Phone:970-495-0444
Practice Address - Fax:970-488-3106
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2013-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO3278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant