Doctor Name: | JANICE J BRADLEY |
NPI Number: | 1508879875 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | 647046 |
Business Practice Address: | 201 N Broadway St Joshua, TX - 760583066 |
Business Phone Number: | 8175584535 |
Business Fax Number: | |
Mailing Address: | Po Box 910, JOSHUA |
State: | TX |
Postal Code: | 760580910 |
Phone Number: | 8175584535 |
Fax Number: | |
NPI Enumeration Date: | 08/15/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 647046 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |