Provider Demographics
NPI:1487367827
Name:BRADSHAW, LISA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BRADSHAW
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 1:29 LOXWOOD ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4578
Mailing Address - Country:US
Mailing Address - Phone:508-887-0529
Mailing Address - Fax:
Practice Address - Street 1:29 LOXWOOD ST APT 1R
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4578
Practice Address - Country:US
Practice Address - Phone:508-887-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2348087163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency