Provider Demographics
NPI:1386826568
Name:BRADLEY, MICHELINE M (RN)
Entity type:Individual
Prefix:
First Name:MICHELINE
Middle Name:M
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5022
Mailing Address - Country:US
Mailing Address - Phone:310-358-8727
Mailing Address - Fax:310-358-8721
Practice Address - Street 1:735 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4208
Practice Address - Country:US
Practice Address - Phone:323-934-7739
Practice Address - Fax:323-934-7752
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse