Provider Demographics
NPI:1316099708
Name:BRADSHAW, MARTHA RAY (RNC,NP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:RAY
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:RNC,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 N HERMAN ST STE CC
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-2971
Mailing Address - Country:US
Mailing Address - Phone:919-731-1000
Mailing Address - Fax:919-731-1611
Practice Address - Street 1:301 N HERMAN ST STE CC
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-2971
Practice Address - Country:US
Practice Address - Phone:919-731-1000
Practice Address - Fax:919-731-1611
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800119363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health