Provider Demographics
NPI:1942392675
Name:COLE, BRADLEY J (APRN,NP-C)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:COLE
Suffix:
Gender:M
Credentials:APRN,NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PLATT WAY
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IL
Mailing Address - Zip Code:61748
Mailing Address - Country:US
Mailing Address - Phone:309-726-1942
Mailing Address - Fax:
Practice Address - Street 1:2406 EAST EMPIRE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-663-9300
Practice Address - Fax:309-661-1670
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health