Provider Demographics
NPI:1013457654
Name:PORTER, BRADLEY SCOTT (RN)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:PORTER
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Gender:M
Credentials:RN
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Mailing Address - Street 1:66 ORCHARD AVE
Mailing Address - Street 2:UPPER APT
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1417
Mailing Address - Country:US
Mailing Address - Phone:716-495-4149
Mailing Address - Fax:716-852-0902
Practice Address - Street 1:170 FRANKLIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2414
Practice Address - Country:US
Practice Address - Phone:716-856-2702
Practice Address - Fax:716-856-8034
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
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Provider Licenses
StateLicense IDTaxonomies
NY643069-1163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management