Provider Demographics
NPI:1356974620
Name:GRAVES BRADFORD, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GRAVES BRADFORD
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 1:5816 RADIANCE PARK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-5259
Mailing Address - Country:US
Mailing Address - Phone:805-535-0943
Mailing Address - Fax:
Practice Address - Street 1:5816 RADIANCE PARK ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-5259
Practice Address - Country:US
Practice Address - Phone:805-535-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider