Provider Demographics
NPI:1134810112
Name:BRADLEY, NICOLE ANNALEE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNALEE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BIRCH HILL DR APT B6
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1450
Mailing Address - Country:US
Mailing Address - Phone:570-250-2411
Mailing Address - Fax:
Practice Address - Street 1:520 BIRCH HILL DR APT B6
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1450
Practice Address - Country:US
Practice Address - Phone:570-250-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle