Provider Demographics
NPI:1386361129
Name:BRADLEY, COLLEEN (RNC-OB)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RNC-OB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4285 ALTADENA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5130
Mailing Address - Country:US
Mailing Address - Phone:858-344-6245
Mailing Address - Fax:
Practice Address - Street 1:4285 ALTADENA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5130
Practice Address - Country:US
Practice Address - Phone:858-344-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400806163WM0102X, 163WN0003X, 163WP1700X, 163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-RiskGroup - Single Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WP1700XNursing Service ProvidersRegistered NursePerinatal