Provider Demographics
NPI:1841273430
Name:BRADWAY-GEMOLL, ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:BRADWAY-GEMOLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:BRADWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6567 E CHOLLA ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5037
Mailing Address - Country:US
Mailing Address - Phone:480-990-7409
Mailing Address - Fax:480-990-7747
Practice Address - Street 1:6567 E CHOLLA ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5037
Practice Address - Country:US
Practice Address - Phone:480-990-7409
Practice Address - Fax:480-990-7747
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZRN051537163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0162440OtherBCBS NUMBER