Provider Demographics
NPI:1932655818
Name:BRADFORD, DANA (RN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BRADFORD
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 1:31 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-3326
Mailing Address - Country:US
Mailing Address - Phone:931-589-2138
Mailing Address - Fax:931-589-5414
Practice Address - Street 1:31 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-3326
Practice Address - Country:US
Practice Address - Phone:931-589-2138
Practice Address - Fax:931-589-5414
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000162773163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health