Provider Demographics
NPI:1245514348
Name:THOMPSON, BRADLEY REGAN (RN)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:REGAN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 S 7TH ST
Mailing Address - Street 2:APT. B
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2104
Mailing Address - Country:US
Mailing Address - Phone:206-601-5442
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7264
Practice Address - Country:US
Practice Address - Phone:253-476-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60113449163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse