Provider Demographics
NPI:1932366887
Name:BRADLEY, PAULA STOCKMAN (PA-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:STOCKMAN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:ELIZABETH
Other - Last Name:STOCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1244 N MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84047
Mailing Address - Country:US
Mailing Address - Phone:801-262-3441
Mailing Address - Fax:801-269-9005
Practice Address - Street 1:1244 N MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074
Practice Address - Country:US
Practice Address - Phone:435-882-3968
Practice Address - Fax:801-269-9005
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT67222221206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical