Provider Demographics
NPI:1063883551
Name:BRADLEY, LAUREN LEWIS (NP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEWIS
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1077 W MORTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1989
Mailing Address - Country:US
Mailing Address - Phone:559-781-5022
Mailing Address - Fax:559-781-6990
Practice Address - Street 1:9300 VALLEY CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8762
Practice Address - Country:US
Practice Address - Phone:559-353-6215
Practice Address - Fax:559-353-6222
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003232363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487980538Medicaid