Provider Demographics
NPI:1699886432
Name:BRADLEY, BARBARA A (RNC, MS, NP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RNC, MS, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MAIN ST 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:978-849-7507
Mailing Address - Fax:
Practice Address - Street 1:340 MAPLE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:508-460-9613
Practice Address - Fax:508-460-0922
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196922363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3644OtherBC/BS
MAP00262193OtherMEDICARE RAILROAD
MA98113OtherFALLEN COMMUNITY HEALTH C
MAP47759Medicare UPIN
MANP3644Medicare ID - Type Unspecified