Provider Demographics
NPI:1801683883
Name:BRADLEY, VANESSA CHANTE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:CHANTE
Last Name:BRADLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-3409
Mailing Address - Country:US
Mailing Address - Phone:937-895-9212
Mailing Address - Fax:
Practice Address - Street 1:44 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-3409
Practice Address - Country:US
Practice Address - Phone:937-895-9212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X, 372500000X, 372600000X, 374U00000X
OH401835870316376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide