Provider Demographics
NPI:1487292173
Name:BRADSHAW, AMBER P
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:P
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 S EXTENSION RD UNIT 259
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-8282
Mailing Address - Country:US
Mailing Address - Phone:480-993-7072
Mailing Address - Fax:
Practice Address - Street 1:2855 S EXTENSION RD UNIT 259
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-8282
Practice Address - Country:US
Practice Address - Phone:480-993-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty