Healthcare Provider Details

I. General information

NPI: 1891132189
Provider Name (Legal Business Name): JENNIFER CARVALHO BRADLEY RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 CONROY LN SUITE 301
ROSEVILLE CA
95661-4156
US

IV. Provider business mailing address

1130 CONROY LN SUITE 301
ROSEVILLE CA
95661-4156
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-6467
  • Fax:
Mailing address:
  • Phone: 916-784-6467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number514578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: