Provider Demographics
NPI:1710695572
Name:BRADFORD, MEGAN E (NP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17195 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-9461
Mailing Address - Country:US
Mailing Address - Phone:616-450-6921
Mailing Address - Fax:
Practice Address - Street 1:990 TERRACE ST # 980
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3395
Practice Address - Country:US
Practice Address - Phone:616-450-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704333059363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner