Provider Demographics
NPI:1639358708
Name:BRADSHAW, TERESA A (CRNFA)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:A
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:A
Other - Last Name:RAINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNFA
Mailing Address - Street 1:4120 W MEMORIAL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9320
Mailing Address - Country:US
Mailing Address - Phone:405-748-3300
Mailing Address - Fax:877-657-5008
Practice Address - Street 1:4120 W MEMORIAL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9320
Practice Address - Country:US
Practice Address - Phone:405-748-3300
Practice Address - Fax:877-657-5008
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0036252163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience