Doctor Name: | MS. SALLY V BRADFORD |
NPI Number: | 1053472506 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNS |
License Number: | 0001045345 |
Business Practice Address: | 5999 Burke Commons Rd Kaiser Permanente Burke Medical Center Burke, VA - 220152880 |
Business Phone Number: | 7032497700 |
Business Fax Number: | |
Mailing Address: | 2101 E Jefferson St, Kaiser Permanente Medicare Enrollment ROCKVILLE |
State: | MD |
Postal Code: | 208524908 |
Phone Number: | 3018162424 |
Fax Number: | |
NPI Enumeration Date: | 12/12/2006 |
NPI Last Update Date: | 12/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0809X |
License Number: | 0001045345 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Psych/Mental Health, Adult |
Taxonomy Definition: |