Provider Demographics
NPI:1104084433
Name:BRADLEY, KATHLEEN PATRICIA (LPN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 OREGON RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1122
Mailing Address - Country:US
Mailing Address - Phone:914-737-1152
Mailing Address - Fax:
Practice Address - Street 1:1030 OREGON RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-1122
Practice Address - Country:US
Practice Address - Phone:914-737-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10193578164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse