Provider Demographics
NPI:1770130213
Name:BRADLEY-DAVIS, NATASHA SHANNETTE
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:SHANNETTE
Last Name:BRADLEY-DAVIS
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 1:1212 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3335
Mailing Address - Country:US
Mailing Address - Phone:618-581-6040
Mailing Address - Fax:
Practice Address - Street 1:1212 PARK PL
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3335
Practice Address - Country:US
Practice Address - Phone:618-581-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347152164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse