Provider Demographics
NPI:1194541995
Name:DANLEY, BRADFORD ALAN (AGACNP-BC)
Entity type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:ALAN
Last Name:DANLEY
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 SQUAW PEAK DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0356
Mailing Address - Country:US
Mailing Address - Phone:702-340-4302
Mailing Address - Fax:
Practice Address - Street 1:3022 S DURANGO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4440
Practice Address - Country:US
Practice Address - Phone:702-340-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV884404363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner