Provider Demographics
NPI:1942793757
Name:BRADBURN, JOHN REESE
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:REESE
Last Name:BRADBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:REESE
Other - Middle Name:
Other - Last Name:BRADBURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:509-663-8711
Mailing Address - Fax:
Practice Address - Street 1:817 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1316
Practice Address - Country:US
Practice Address - Phone:509-548-5815
Practice Address - Fax:509-548-2510
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60904634363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant