Healthcare Provider Details

I. General information

NPI: 1588683213
Provider Name (Legal Business Name): BRONWYN KATHLEEN RADCLIFFE F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRONWEN LEWIS FNP

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 COUNTY ROAD 503
BAYFIELD CO
81122-9305
US

IV. Provider business mailing address

355 COUNTY ROAD 503
BAYFIELD CO
81122-9305
US

V. Phone/Fax

Practice location:
  • Phone: 970-238-0438
  • Fax:
Mailing address:
  • Phone: 970-238-0438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01758
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164985
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number100066-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: