Provider Demographics
NPI:1750825386
Name:BRADLEY, PAM D (RN)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:D
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:DENISE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:111 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1710
Mailing Address - Country:US
Mailing Address - Phone:330-750-1062
Mailing Address - Fax:330-755-4525
Practice Address - Street 1:111 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1710
Practice Address - Country:US
Practice Address - Phone:330-750-1062
Practice Address - Fax:330-755-4525
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.329696163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool