Provider Demographics
NPI:1689298747
Name:GIRTEN, BRADLEY THOMAS (RN)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:THOMAS
Last Name:GIRTEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 GOODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-4846
Mailing Address - Country:US
Mailing Address - Phone:513-208-6516
Mailing Address - Fax:
Practice Address - Street 1:1819 GOODMAN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4846
Practice Address - Country:US
Practice Address - Phone:513-208-6516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH394606163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse