Provider Demographics
NPI:1922073667
Name:BRADSHAW, PAULINE L (APN)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:L
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-0940
Mailing Address - Country:US
Mailing Address - Phone:775-463-2301
Mailing Address - Fax:
Practice Address - Street 1:213 S WHITACRE ST
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-2561
Practice Address - Country:US
Practice Address - Phone:775-463-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000649363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP45542Medicare UPIN
NV35703Medicare ID - Type Unspecified