Provider Demographics
NPI:1407005051
Name:BRADLEY, BLUE E (CNM, ARNP)
Entity type:Individual
Prefix:
First Name:BLUE
Middle Name:E
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-1340
Mailing Address - Country:US
Mailing Address - Phone:509-689-2525
Mailing Address - Fax:
Practice Address - Street 1:541 W. SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-422-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60035365363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health