Provider Demographics
NPI:1457340028
Name:BRADBURY, MARY LOUISE (ARNP FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOUISE
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:ARNP FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8182 W CIRCULO DE LOS MORTEROS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-8204
Mailing Address - Country:US
Mailing Address - Phone:509-995-6358
Mailing Address - Fax:
Practice Address - Street 1:50 E CROYDON PARK RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5792
Practice Address - Country:US
Practice Address - Phone:520-696-3438
Practice Address - Fax:520-888-2347
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006556363L00000X
AZAP2489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1046069OtherDEA
1046069OtherDEA