Provider Demographics
NPI:1992869176
Name:BRADLEY, WILLIAM ALLAN (ACNP-BC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALLAN
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BON AIR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1141
Mailing Address - Country:US
Mailing Address - Phone:415-927-0666
Mailing Address - Fax:415-927-6919
Practice Address - Street 1:2 BON AIR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1141
Practice Address - Country:US
Practice Address - Phone:415-927-0666
Practice Address - Fax:415-927-6919
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF12474363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP37875Medicare UPIN
CAZZZ21324ZMedicare ID - Type UnspecifiedMEDICARE PORVIDER