Healthcare Provider Details

I. General information

NPI: 1851323117
Provider Name (Legal Business Name): BRADLEY BENJAMIN NICHINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 ADAMS ST SUITE 300
SAINT HELENA CA
94574-1148
US

IV. Provider business mailing address

999 ADAMS ST SUITE 300
SAINT HELENA CA
94574-1148
US

V. Phone/Fax

Practice location:
  • Phone: 707-481-8790
  • Fax:
Mailing address:
  • Phone: 707-481-8790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG56759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: