Provider Demographics
NPI:1801212733
Name:BRADSHAW, MARY (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4941
Mailing Address - Country:US
Mailing Address - Phone:803-773-5511
Mailing Address - Fax:803-775-7163
Practice Address - Street 1:105 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4941
Practice Address - Country:US
Practice Address - Phone:803-773-5511
Practice Address - Fax:803-775-7163
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24448163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse