Provider Demographics
NPI:1194958066
Name:BRADLEY, LAURA SELDEN (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SELDEN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-594-2195
Practice Address - Street 1:12200 WARWICK BLVD
Practice Address - Street 2:STE 410
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2548
Practice Address - Country:US
Practice Address - Phone:757-534-5200
Practice Address - Fax:757-534-5530
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0001138716163W00000X
VA0024168288363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse