Provider Demographics
NPI:1710167895
Name:BRADLEY, BROOKE ANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ANNE
Other - Last Name:MCCUEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2104 CEDARWOOD DR LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2669
Mailing Address - Country:US
Mailing Address - Phone:319-688-7921
Mailing Address - Fax:319-688-7776
Practice Address - Street 1:2104 CEDARWOOD DR LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2669
Practice Address - Country:US
Practice Address - Phone:319-688-7921
Practice Address - Fax:319-688-7776
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA110099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1710167895Medicaid
IA1710167895Medicaid