Provider Demographics
NPI:1700122306
Name:BRADBURY, JULIA C (APRN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:C
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:C
Other - Last Name:THEIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:36123 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1216
Mailing Address - Country:US
Mailing Address - Phone:913-660-1616
Mailing Address - Fax:913-660-1664
Practice Address - Street 1:501 ASSEMBLY LN
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1854
Practice Address - Country:US
Practice Address - Phone:913-660-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013001303363LA2200X
KS5375786061363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111023005Medicare PIN
KSR28000005Medicare PIN
MOR28A00005Medicare PIN
KS201012650AMedicaid