Provider Demographics
NPI:1811168719
Name:BRADSHAW, JANE ELIZABETH (RN, IBCLC, RLC)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELIZABETH
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 OLD FOREST RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2335
Mailing Address - Country:US
Mailing Address - Phone:434-384-6262
Mailing Address - Fax:
Practice Address - Street 1:2900 OLD FOREST RD
Practice Address - Street 2:SUITE F
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2335
Practice Address - Country:US
Practice Address - Phone:434-384-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001075277163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant