Provider Demographics
NPI:1205958840
Name:BRADFORD-LEWIS, EMILY RUTH (FNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RUTH
Last Name:BRADFORD-LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 CHERYL ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374
Mailing Address - Country:US
Mailing Address - Phone:951-367-5734
Mailing Address - Fax:909-886-0328
Practice Address - Street 1:355 E 21ST ST
Practice Address - Street 2:STE H
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4851
Practice Address - Country:US
Practice Address - Phone:909-886-2609
Practice Address - Fax:909-886-0328
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P09070Medicare UPIN