MEDICARE: MRS. DENISE MARIE BRADLEY LPN

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	164W00000X	Licensed Practical Nurse	PN275771	PA

General Provider Information

NPI Number	:	1528273208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE MARIE BRADLEY LPN

Provider Business Mailing Address
First Line	:	1538 S HOLLYWOOD ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19146-3516
Country	:	US
Telephone Number	:	215-962-7526
Fax Number	:

Provider Business Practice Location Address
First Line	:	1538 S HOLLYWOOD ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19146-3516
Country	:	US
Telephone Number	:	215-962-7526
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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