Healthcare Provider Details

I. General information

NPI: 1831128016
Provider Name (Legal Business Name): CATHERINE SUE BRADWAY MSN, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W BASELINE RD SUITE B258
MESA AZ
85202-5820
US

IV. Provider business mailing address

4747 N 7TH ST SUITE 100
PHOENIX AZ
85014-3653
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-0825
  • Fax: 480-820-7863
Mailing address:
  • Phone: 602-279-7655
  • Fax: 602-264-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number092864
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP4159
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: