Doctor Name: | REBEKAH YVONNE BRADTKE |
NPI Number: | 1124197538 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1213 12th Ave Se Suite 103 Dyersville, IA - 520402416 |
Business Phone Number: | 5638752344 |
Business Fax Number: | 5638752344 |
Mailing Address: | 1213 12th Ave Se, Suite 103 DYERSVILLE |
State: | IA |
Postal Code: | 520402416 |
Phone Number: | 5638752344 |
Fax Number: | 5638752344 |
NPI Enumeration Date: | 11/07/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |