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NPI Code Detail

MEDICARE: GILLIAN MARY BRADLEY CRNP

MEDICARE: GILLIAN MARY BRADLEY CRNP
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
1363L00000XNurse PractitionerSP032011PA

General Provider Information

NPI Number : 1972316339
Entity Type Code : Individual
Provider Name (Legal Business Name) : GILLIAN MARY BRADLEY CRNP
Provider Business Mailing Address
First Line : 1031 FERNON ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19148-1107
Country : US
Telephone Number : 856-304-2692
Fax Number :
Provider Business Practice Location Address
First Line : 3400 SPRUCE STREET
Second Line : 3 WEST GATES
City : PHILADELPHIA
State : PA
Zip : 19104-4238
Country : US
Telephone Number : 215-662-3361
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2025
Last Update Date : 01/29/2025

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