MEDICARE: BRADLEY SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	RN117214	AZ

General Provider Information

NPI Number	:	1083336978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY SMITH

Provider Business Mailing Address
First Line	:	4400 W IRVINGTON RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-8425
Country	:	US
Telephone Number	:	520-908-4516
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 W IRVINGTON RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-8425
Country	:	US
Telephone Number	:	520-908-4516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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Directions to “ BRADLEY SMITH ” Practice Location

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