Healthcare Provider Details

I. General information

NPI: 1093197790
Provider Name (Legal Business Name): CHARITY ANN BRADLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BRUCE ST
YREKA CA
96097-3474
US

IV. Provider business mailing address

475 BRUCE ST
YREKA CA
96097-3474
US

V. Phone/Fax

Practice location:
  • Phone: 530-841-4980
  • Fax: 530-841-9412
Mailing address:
  • Phone: 530-841-4980
  • Fax: 530-841-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number543809
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: