Provider Demographics
NPI:1770751687
Name:BRADSHAW, GEORGIANA (RN)
Entity type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4413
Mailing Address - Country:US
Mailing Address - Phone:832-237-3500
Mailing Address - Fax:832-237-0200
Practice Address - Street 1:3 RIVERWAY
Practice Address - Street 2:SUITE 825
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1919
Practice Address - Country:US
Practice Address - Phone:713-840-5245
Practice Address - Fax:281-897-9906
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX632417133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist