Provider Demographics
NPI:1801382775
Name:BRADFORD ELLIOTT, AMBERLEA DAWN (APRN-CNS)
Entity Type:Individual
Prefix:
First Name:AMBERLEA
Middle Name:DAWN
Last Name:BRADFORD ELLIOTT
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:AMBERLEA
Other - Middle Name:DAWN
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-CNS
Mailing Address - Street 1:7809 NW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3139
Mailing Address - Country:US
Mailing Address - Phone:405-659-9423
Mailing Address - Fax:
Practice Address - Street 1:4300 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8304
Practice Address - Country:US
Practice Address - Phone:405-486-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92328364SN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SN0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeuroscience