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NPI Code Detail

MEDICARE: MS. DORA LINDA BRADFORD RNC,BSN,WHNP

MEDICARE: MS. DORA LINDA BRADFORD RNC,BSN,WHNP
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
1363LW0102XWomen's Health Nurse Practitioner532543TX

General Provider Information

NPI Number : 1164666517
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DORA LINDA BRADFORD RNC,BSN,WHNP
Provider Business Mailing Address
First Line : 2910 HOLLOW OAK DR
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75052-7793
Country : US
Telephone Number : 972-602-1552
Fax Number :
Provider Business Practice Location Address
First Line : 2106 N MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76164-8511
Country : US
Telephone Number : 817-625-4254
Fax Number : 817-625-8451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2009
Last Update Date : 11/27/2012

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