Provider Demographics
NPI:1427060847
Name:BRADLEY, CATHY A (FNP)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769
Mailing Address - Country:US
Mailing Address - Phone:207-764-9700
Mailing Address - Fax:207-764-9703
Practice Address - Street 1:521 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769
Practice Address - Country:US
Practice Address - Phone:207-764-9700
Practice Address - Fax:207-764-9703
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER039083363LP2300X
MECNP81391364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME100064OtherANTHEM ID#
ME3670340OtherAETNA ID
ME252580099Medicaid
MENP3354Medicare PIN